Skill Building & Capacity I:
Developing and Maintaining the
Collaborative Team
1
Welcome to the Developing and Maintaining the Collaborative Team Workshop brought
to you by The Network Environments for Aboriginal Health Research BC (NEARBC –
Northern Node) in collaboration with the University of Northern British Columbia, BC
Rural and Remote Health Research Network and Northern Health.
In today’s world the role of collaboration has become the most effective way of
conducting research and in the provision of services. The collaboration between
organizations, communities and individuals is often done through the formation of
“teams”. However, the formation of a team moves beyond just a group of individuals with
“good intentions” but is a delicate balance of relationships between each other, the
organization and community. Leadership style, trust, sharing information, and problem
solving are key areas in the establishment of effective team work. A team is also a
sliding continuum and in a constant state of change. The influence of obvious and subtle
factors has a rebound effect on team functions and can quickly turn an effective and
established team into chaos. The measurement of a teams' developmental stage is not a
reflection of “negative” or “positive”; it is but a sliding scale of growth and development.
This workshop brings together researchers, community, organizations, students and
concerned individuals in an effort to provide a foundation, or a bridge of skills, to create
increased capacity in team work.
The format of the workshop is one of integrated team building skills, knowledge and
education. This workbook is a supplement to your workshop instruction.
Several icons will draw your attention to specific actions throughout the day:
Means a group or individual exercise
A section for your notes
2
Take away
skill building
Workshop Schedule Day One
9:00 am – 4:00 pm
October 13, 2009
Learning objectives : DAY ONE
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9:00 am – 9:40 am
9:30 am – 10: 15 am
10:15-10:30
1.
2.
3.
4.
Identify the need for and importance of collaboration
Describe the different types of teams
Describe the phases of team development
Demonstrate components of successful teamwork
Greetings and Introduction
Housekeeping & Structure of the Workshop
Respect
What YOU want to learn at this workshop (Charting)
Round Table team
introductions
(5 of 5)
Workbook Page 6: Exercise in team formation
BREAK
Workshop Schedule
10:30-11:30
Team Basics 101
11:30 – 12:00
The Plan
Workbook Pages 7-14
Practice Plan Exercise
Lunch Break
12:00 pm – 1:00 pm
1:00 pm – 3:00 pm
Theory and Principles
3:00 pm – 3:15 pm
BREAK
3:15- 3:45
Practice Skills Breakout
Workbook Pages 15-24
Practice Plan Exercise
3:45- 4:00
Debriefing & Closure for Day
Evaluation
3
MODULE ONE
Table of Contents
Language and Meanings
Pages
………………………………………………………
Team Basics 101 …………………………………………………………………………
5
6-8
1. Team Working Exercise
2. Team vs Work Group
3. Types of Teams
4. Structure of Teams
The Collaborative Team ………………………………………………………………
1.
2.
3.
4.
5.
6.
7.
8.
9.
9-14
Types of Collaboration
Characteristics of Collaboration
Seven Essential Elements for Collaboration
Challenges of Collaboration
When to Develop a Collaborative Team
Team Essentials (Chart)
Elements of Team Formation
A Collaborative Team is / is not (Group Exercise)
Where would you find the Collaborative Team?
Theory & Models ……………………………………………………………………… 15-20
1.
2.
3.
4.
Phases of Team Formation
Aspects of Team Formation
Sliding Continuum of team Development Stages (Chart)
Aspects Affecting Team Development
5. Team in Context of environmental variables (Chart)
Principles of Successful Teamwork ………………………………………………
1. Characteristics of Effective Teams
2. Developing Team Member Vision and Rules
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21-23
Language and Meaning
Drinka & Clark (2000) note that “each discipline views themselves as somewhat exclusive, unique
and special” and there is a certain culture of language that is used to separate and divide—to
maintain discipline status. The goal of inter-professional practice is to understand that no single
discipline can address complex health problems.
Team Formation Team is a process that is structured and guides the actions of two or more
individuals within both the expectations of the organization and that of the patient (client, participant)
(Drinka & Clark, 2000).
Team - A team is a group of people who collaborate and interact to reach a common goal
Inter-professional – A fully integrated practice by a team of professionals from a diverse background
of disciplines. Each member of the team has an integrated knowledge of the other team members’
roles, and all work from an equally valued team mandate. “When two or more professions purposely
interact in order to learn with, from and about each other to improve effectiveness and the quality of
care” (Gilbert, 2001).
Collaboration – An effort to consult and co-operate as a group or team in developing a shared
direction or vision. Each member still maintains a separate functional identity. A collaborative practice
is an active and often ongoing practice partnership between professionals, teams or organizations”
(Gilbert, 2001).
Integration – The merging of differences into a single vision – a dependency between the parties
where all hold equal value.
Patient-Centered - Patient-centered practice recognizes that the patient’s participation in the
development and implementation of his/her care plan is integral. A patient-centered approach
recognizes that health care is influenced by genetic, environmental, social and behavioural factors.
Person (people) Centered— Describes that not only are patients at the center but also healthy
community members. It is a term “most often used to refer to health care systems that offer service
to healthy individuals, as well as those with acute or chronic health concerns” . . . “understood for
what it is not—technology centered, doctor centered, hospital centered, disease centered”.
(Vancouver Coastal Health, 2006).
Determinants of Health - The Public Health Agency of Canada states the determinants of health
“are: income and social status; social support networks; education; employment/working conditions;
social environments; physical environments; personal health practices and coping skills; healthy child
development; biology and genetic endowment; health services; gender; and culture. Each of these
factors is important in it’s own right. At the same time, the factors are interrelated” (Cited on web
site:http://www.phac-aspc.gc.ca/ph-sp/phdd/determinants/determinants.html#unhealthy).
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Team working moment
Consider these questions:
1.
2.
3.
4.
5.
6.
What are your experiences with team work?
What types of teams can you indentify?
Who were members of these teams?
What were the qualities that made the team work?
What were the challenges?
What impact does your past experience have on your perception of
team work?
Your Notes:
6
Team Basics 101:
Team vs. Work Group
Work Group
Team
One “boss” each member reports too group does
not necessarily collaborate with each other
The leader is not a boss but a coach or facilitator to the
team
Each person completes tasks as per job
description and Boss directives.
A group of individuals with complementary skills
committed to a common/shared goal/vision
Emphasis on individual performance
Interdependence and accountability between team
members is encouraged
Uni-directional: Communication flows down from
boss to individual
Dual directional: Communication is both top down and
bottom up
Boss is the authority and directs work processes
Team has the authority to manage it’s own work
processes
Goals set by organization
Clear boundaries and tasks
Types of Teams
1.
2.
3.
4.
5.
6.
7.
8.
Working Team
Project Team
Special Team
Research Team
Multi-purpose Team
Independent Team
Management Team
Trouble Shooting Team
ONSITE, OFFSITE. VIRTUAL:
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Discuss your experiences with each .
What are the strengths and challenges
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Structure of Teams
MultiDisciplinary
Collaborative
(Facilitated)
InterProfessional
Team
Uni-disciplinary
Workgroup
Multidisciplinary
(unidirectional)
Interdisciplinary
Unidisciplinary:
A group of people from the same discipline who work together.
Multidisciplinary:
A group of people from different disciplines who develop plans independently.
Generally, each discipline conducts an independent assessment of their interest group. Often
one discipline is the case manager, orders the services and coordinates the care. The group
may meet but, in general, each discipline implements its independent plan as an additional
layer of services.
Interdisciplinary:
A group of people from different disciplines who assess and plan care in a collaborative
manner. A common goal is established and each discipline works to achieve that goal.
Care is interdependent, complimentary, and coordinated. Joint decision making is the
norm. Members feel empowered and assume leadership on the appropriate issue
(depending upon needs and their expertise).
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The Collaborative Team
Types of Collaboration:
1.
2.
3.
4.
5.
Day to day
Clinical teams (health or disease focus)
Integrated teams
Cross integration: mandated and non-mandated
Consultative
Characteristics of Collaborative Practice Include (MCFD, 1997):
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Active participation of the client
Sharing or transferring of information and skills across traditional boundaries
Participants view themselves as part of a team and contribute to a common goal
Relationship between participants is non-hierarchical and power is shared
Leadership is shared and participants are inter-dependent
Participants work together in planning and decision making
Participants offer their expertise, share in the responsibility and are acknowledged by
other members of the group for their contribution to the goal
Clear definition and understanding by team members of participants' roles/responsibilities
Respect for autonomous professional judgement and decision making of the client/family
Effective communication skills and group dynamics
Supported by organizational structures and vision
Seven Essential Elements for Collaboration (Way & Jones, 2001)
1. Responsibility and Accountability
 Independent and Shared
 Shared decision making
 Accept shared responsibility for the outcome of the care plan
2. Co-ordination
 Joint decisions about who will do what to ensure that the care plan is carried out
3. Communication
 Sharing with the other providers critical information
 Information is relevant, concise and timely
 Clear identification of information sharing expectations
4. Co-operation
 Respecting other disciplines’ professional opinions and viewpoints
 Being willing to examine and alter your own professional views and perspectives
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5. Assertiveness
 Opinions and view points presented in a manner that fosters the integration of
approaches
6. Autonomy
 Providers can independently make decisions and carry out the care plan
7. Mutual Trust and Respect
 Provider able to depend upon the integrity of the other as the foundation for their
professional relationship.
Challenges of Collaboration:
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“Group Think”
Becoming homogeneous
Becoming too ridged / structured
Slowness
Trust
Not everyone comes to the team with an equal value
Member reward differences
Some can ---- Some can’t ------ Some will ---- Some won’t
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When to Develop a Collaborative Team
When
Benefits
Challenges
No one individual has the right
combination of skills, knowledge
and practice to do the job
Can be creative and unique approach
Time to organize
Teams can bring multi-skills to bear on
intractable situations
Must be managed with care and
skill
Enlist more information and ability by
tapping into different skill sets and
networks
Silos
Increased collaboration and
communication
Knowing who to involve
The situation is multi-faceted,
complex and/or a unique /
infrequent challenge
Requires a high degree of
interdependence, coordination
and communication
Buy in
Knowing when to involve them
When the objectives are clear but
multi-leveled
Can be more “person focused”
Developing the right combination of
skills, knowledge and experience
Balancing time, authority and
systemic issues
Your Notes:
11
Clear Common Goal
Team Member selection
A supportive
environment (Physical
and Systemic)
Competence
Defined performance
expectations
Membership manual –
road map – welcome
package
TEAM
Co-location
ESSENTIALS
Organizations are
compatible with team
based work
Commitment to Common
Goals
US, WE, OUR
Each member
contributes and benefits
Supportive Leader &
Mentor
Elements of Team Formation
1. Systemic – Management Support
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Support from all involved levels of the organization (union, directors, managers, policy etc)
Budget / Financial commitment defined
Environmental structures: works space, supplies, transportation and equipment.
Agreements at the upper levels
Clearly defined reporting, documenting and decision authority
2. Team Vision & Agreement
 Provides the means of “how” to meet the memo of agreement and is specific to each team.
 Provides the commonality, contribution and direction of the team
 Defines the team – clearly outlines roles, times of involvement and expectations
 Defines the relationship and interaction of members
 Defines reporting, conflict management and communication
 The approach to decision making for the team (i.e.: work schedule, plans and holidays)
 Clarify objectives – team vs. employer
 Environmental Factors: Co-location – work space – equipment – Kitchen
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3. Team member selection
Team member selection is the hardest part of team formation, however, membership is critical to team
cohesiveness and success.
Three methods of coming to a team:
Assigned
Voluntary
No choice Part of
job
Nominated
Want to be involved
Choice
Committees
Elected process
Non Profit
set time
Factors:
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Skills (Technical, problem-solving, interpersonal, organizational)
Potential
Open
Flexible
Collective
Role – short or long term team member
Behaviors:
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Attendance
Involvement
Interruptions
Ability to offer and accept constructive criticism
Agree to discuss and share information
Confidentiality
Action oriented
4. Team based Leadership
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Every team needs a leader but not necessarily as a “BOSS”
Coach, Mentor, working member of the team
Keep the vision focus
Smooth out conflict
Mediates – in particular “turf” or “Silo” ing
Co-ordination of activities
Act as a liaison between team and community / systemic
Negotiate relationships
Identify gaps and resources
Obtain resources
Set and monitor milestones
Ensure member involvement, contribution and benefits
Keep work on track
Differs from Work Group
1. Decision Maker, delegator, and scheduler
2. BOSS – with bottom line of direction and results
3. Stands outside of the team – or as the top of the hierarchy
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YOUR NOTES
A Collaborative Team IS?
IS NOT?
Where would you find Collaborative Teams?
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Research
Primary health (pre/post natal,
obstetrics, new born care)
Mental health care
Addiction Treatment
Outreach
Palliative Care
In home support
Education & Prevention
Chronic disease management
Maternal & child care supports
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Occupational health
Community health
Care of the vulnerable
Rehab services
Parenting
Social and community services
Counseling
Family services
Youth service
Theory & Models
The definition of a team is broad and crosses all disciplines, practices and education forums. However, despite
the variant of models there exists the fundamental understanding that a team moves beyond just a “group” of
people. At its fundamental level a team is an integrated, directed group of individuals who share a common goal
and vision. Researchers note that a team is a fluid concept, not one that is based on an automatic template
format. Team development is not static and linear, but is based on an evolutionary process of growth. The
concept of evaluation of team development and effectiveness has its foundation in the field of business and sales
management - Tuckman, Parker and LaFasto are some of the recognized leaders in this area, and their concepts
form the foundation for many of the discipline specific models that have been developed. The Tuckman model is
considered the standard foundation of the team processes.
TUCKMAN MODEL:
There is a general consensus amongst researchers that, the beginning standard, for evaluating team
performance and formation, is based on Tuckman’s (1965) model stages of: forming, storming, norming and
performing (Farrell et.al., 2001). Within this model, team dynamics move through a predicable format of
development and growth, but the process is subject to the impact of individual team dynamics and environment.
Essentially, the forming stage is the one in which a new team comes together and begins to develop team
processes, expectations and roles. The storming stage is the one in which the team goes through the conflict of
team growth—this is the stage in which the clashes of personality, mandates and roles become issues and need
to be worked out. The norming stage of development is the time in which the team begins to collaborate and
work within the established roles brought about in the storming stage of development. The performing stage is
when the team has meshed into a collaborative unit and is no longer focusing as much on the internal team
process but is able to function and achieve goals.
However, as the team evaluation concepts expands into the disciplines outside of the business arena, the need to
capture the influences of the work environment on team practices increases.
In the health care field the impact of the patient, staffing and community relationships on the team dynamics is
critical to team performance. Several models have been developed to try and capture the uniqueness of the
Health Care team for example, Drinka, Heinemann and Mead all have established health care models.
DRINKA MODEL
Drinka & Clark (2000), expand Tuckman’s model by adding the layer of “leaving”, which acknowledges there is
significant impact on team efficiency due to high rates of staff turnovers and/or students. This model also presents
“four essential team components and their variables” which define the effectiveness of the health care team as
issues that directly affect practice, Intra-team issues, Organizational issues and Actions necessary for team
maintenance. Fundamentally, integrating the models proposed by Tuckman, Parker and LaFasto & Larson into
single model concept
HEINEMANN MODEL
Heinemann and Zeiss,(2002) established a concept of best team practices in health care within the Tuckman
model, but identified health care teams as having a unique structure that cannot be articulated in the same format
as general team structures. The Heinemann & Zeiss model concludes that the effectiveness of the health care
team is defined within the four categories of structure, context, process and productively, which mirrors much of
the Drinka & Clark model, (with the exception that Heinemann & Zeiss model de-emphasis the impact of
individual factors on the team effectiveness).
MEAD MODEL
Mead, 2005 argues that primary health care is moving towards Inter-professional practices as health care costs
continue to rise and the adoption of integrated team work is driven by finances, practices and professional
effectiveness. Mead suggests there are five levels that must be achieved and integrated: Collaboration,
Accountability, Focusing, Development, and Education. Within the Mead model best practices are the result of a
15
balance between the inter-professional relationships (professional, partners, policy, public and patients),
organizational structures/systems/processes and a holistic commitment. The extent that a team is able to achieve
success in the provision of inter professional practices is also based on the preconditions of
 Directness – Clear roles, responsibilities, conflict management, expectations and supportive
process
 Multiplexity
 Continuity – Consistency for team, partners, community
 Parity – Equality of power, authority and participation
 Commonality – of goals, visions and mandates
Benefits and Perks (incentives of collaboration) – Improved outcomes, personal/professional
organization/community
Phases of Team Formation
Groups do not become well-functioning interdisciplinary teams by deciding to become a team. All teams develop
through a series of phases each of which can last several months or longer. Sometimes a developed team will
even return to a previous phase for a period of time and work out of it. Tuckman first labeled these phases and
many experts who work with groups use these labels:
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Forming: creation stage for the group.
Storming: tasks and roles are worked out through conflict.
Norming: norms and patterns are worked out.
Confronting: conflictual stage (some professionals use this label or the storming label but not both).
Performing: team working together for the care of the patient.
Drinka has described six phases of team development – and presented stages and interventions:
Forming:
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Group is created.
Superficial sharing of name and background information.
Members size up and test each other categorizing with outside roles and status.
Members are guarded, more impersonal than personal, a few are active, others are passive.
Uncertainty over purpose.
Conflict is neither discussed nor addressed.
Norming:
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Difficulty in understanding goals and purpose of the team.
Attempt to establish common goals.
Mistrust of each other exhibited by caution and conformity.
Role overlaps become evident.
Conflicts are present but are openly covered up or glossed over.
A few members attempt to establish bonds with others having similar views.
Team establishes ground rules and begins to clarify common roles.
Team may want leader(s) to assume responsibility.
Numerous strategies for increasing equality of leadership (e.g., rotating leadership).
Increase in defensive communication and disruptive behavior.
Frustration among team members.
Some members project blame and responsibility toward the perceived leaders.
Competition among team members.
Some members come late or do not come to meetings.
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Confronting:
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Conflicts can no longer be avoided and some members verbally attack other members.
Increased conflicts over leadership, equality, and commitment
Anxiety over expression of affect.
Some conflicts are addressed in a direct manner.
Some members withdraw from the team.
Search for leader who will resolve conflicts.
Functional leaders emerge.
Realization that power is not equal.
Realization that everyone has power for leadership and decision making.
Constructive confrontation when conflict occurs
Goals and roles are re-clarified.
Coalitions form but change according to needs of the team.
Performing:
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Differences of members are appreciated.
Members encourage and help each other.
Reality testing increases and grows stronger.
Self-initiated active participation is the norm.
Relationships are strengthened and members must trust each other.
Attendance at meetings is regular.
Conflicts seen as normal and are used as impetus for program improvement.
Emphasis on productivity and problem solving.
Increased responsibility for leadership in teaching, wherever skills warrant it.
Leaving:
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Individual leaves.
Anger toward members of the team in general.
Denial of impending termination from team by disbelief and regret.
Expression of wish to remain with the team.
Regression to an earlier phase.
Member may express happiness over leaving the team.
Team Terminates.
Withdrawal by some members, depression, sadness.
Expressions of team’s superiority.
Feelings are expressed as testimonials.
Need to affirm that team membership has been a valuable experience.
Your Notes:
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Chart One: A Sliding Continuum of Team Developmental Stages
The impact of the leaving stage, member turnover or student involvement, is a sliding scale and is dependant
upon on factors such as stage of team operation, individual personalities, time of team membership and
organizational influences. Consequently, there is no set pattern of impact when a member of the team leaves,
nor is there a predetermined movement within the stages of development. The degree of the impact on teams
vary for example, students joining has more of a impact then when they leave the team. Often cited reasons,
regarding student impact, is the responsibility of mentorship, student class responsibilities and a layering of
supervision internally and externally.
Supportive
Good
Communication
Stage Four :
Effective
Team
COHESION &
Consensus
(Norming)
Tightly Knit Trust”
we-ness”
Harmony
Cooperation
Stage three:
Sharing Group
Ownership
Safety
CONFLICT
(Storming)
Resistance
Leadership
Struggle
disagreement
Stage two:
Fractionated
Group
Encounter
Task-Oriented
Confrontation
Issue-Oriented
Polarization
DEPENDENCY &
Testing
(Forming)
Stage one:
Immature
Group
Inefficiency
Search for
procedures
Telling-Asking
One way
communication
Experting
Leadercentered
Decision
making
ORIENTATION
Context
ORGANIZATION
Structure
OPEN DATA
FLOW
process
PROBLEM
SOLVING
productivity
TASK BEHAVIOURS
(Based on Models proposed by Tuckman, as outlined in Farrell et al. , 2001; Drinka & Clark, 2000; and
Heinmann & Zeiss, 2002)
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IMPACT
Flexibility
Negotiating
STUDENT
Free expression
of “feelings”
TURNOVER - Leaving Stage
INTERDEPENDENCE &
Functional
(Performing)
Aspects Affecting Team Development
Several variables can affect the development of teams. These variables fall under four specific areas:
1) Personal/professional (what the individual brings to a team);
2) Intra-team (the structure and processes of the team);
3) Organizational (institutional contributions and commitment to the team);
4) Team maintenance
Personal/Professional
 Commitment to team concept;
 Willingness to engage in the work of the team and to improve it;
 Commitment to learn the values and knowledge bases of other professions;
 Mix of leadership styles;
 Openness to new knowledge and willingness to risk;
 Collective knowledge to do the job;
 Mesh of client needs and professional expertise;
 Interdisciplinary protocols developed and used by the team.
Intra-Team
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Desk/office placement and structure for formal/informal interaction;
Physical arrangement and technology
Range of formal and informal team leaders ;
All members view themselves and are recognized by others as leaders;
Employ leadership according to the need;
Common goals;
Team goals are negotiated and reviewed periodically by the team;
Negotiated roles;
Members understand their team roles;
Ongoing mechanisms for managing conflict;
Conflict viewed as healthy;
Willingness to address conflicts as they rise;
All team members perceived as having power for decision-making.
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Organization’s philosophy consistent with the team’s philosophy on patient care;
Ongoing resource support from local organization;
External organization(s) recognize and are willing to work on common problems.
Organizational
Team Maintenance
 Team regularly evaluates and improves itself (products, protocols, and
 processes);
 Team empowers new members’
 Members teach team leadership skills to newer members;
 Team members welcome a questioning environment;
 Feedback is open and direct.
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Chart Two: A Team in Context of Environmental Variables
Overlapping the model of team developmental stages are also the evaluative measures as outlined in this chart.
Intra-Team Issues
Context
Organizational
Issues
Structure
Actions necessary
for Team
Maintenance
Productivity
Personal
Professional
Team
Structure
Team Process
Internal
External
Organization
Team
Organization
Age
Expertise in
specialty
Formal
leadership
Norms
Negotiating
informal
leadership
Team
Philosophy
National
policy
Use power
for decision
making
Communicates
a clear mission
statement
Composition
Goal setting
Resource
allocation
Funding
sources
All free to
disagree
Formal roles
Appreciating
values
Rigid vs.
flexible
rules
Philosophy
Interdisciplinary
values
Team feedback
to develop and
ongoing revise
mission
Gender
Dedication
Culture
Respect for
professional
differences
Communicati
on skills
Team culture
Energy
Styles of
relating
Professional
status
Willingness to
share client
Physical
placement
Professional
maturity
Structured
for
interaction
Leadership
styles
Knowledge of
roles of others
Openness
Knowledge of
systems
Personal
knowledge
Maturity
Negotiating team
roles
Building trust
Willingness to
risk
Flexibility’
Knowledge of
health
determinate
Structured
for
innovation
Simple/com
plex
structure
Communicating
Evaluates
and
manages
itself
Mentorship
leadership
to new
members
Problem solving
Team to
manage itself
Gives
constructive
feedback to
team
Responds in a
problem solving
manner to the
teams’ requests
Problem solving
influences
Managing
conflict
Knowledge of
ways different
professionals
problem solve
Meanings – Language – Priorities (Directness – Elimination of Jargon)
(Based on Models proposed by Tuckman ,as outlined in Farrell et al. , 2001; Drinka & Clark, 2000; and
Heinmann & Zeiss, 2002)
20
Student Impact
Values - Socialization
Issues that directly
affect Practice
Process
Principles of Successful Teamwork
The key essential principles of teamwork are:
1. Coordination of services,
2. Shared responsibility, and
3. Communication.
Effective teams must work across settings and have well-organized
mechanism to share information. Because the focus of the team is on
the person, providers must share information clearly and effectively. By
focusing on the client, the team shares a common goal.
Characteristics of Effective Teams













Purpose, goals, and objectives are known and agreed upon.
Roles and responsibilities are clear.
Communication is open, sharing, and honest. There is disagreement without
tyranny and constructive criticism without personal attack.
Team members listen to each other.
Team members are competent, professional, personally effective, and make
appropriate contributions.
Teams cooperate and coordinate activities. Decisions are reached by
consensus.
When decisions are made, assignments are made clearly, accepted, and
carried out.
Leadership shifts depending on the circumstances.
Team members support each other and act as different resources for the group.
Team members trust each other, minimize struggles for power, and focus on
how best to get the job done.
What type of vision, rules, expectations or agreements does your team have?
Are some unspoken?
How is this information shared with new team members?
21
Developing Team Member Vision & Rule
Team rules, both for team management and for member behavior, are needed in the early stages of team
development. Not having these rules is a primary cause of later team problems and can slow or stop
team development completely. Rules for team governance should include some or all of the following:









All members share a clear understanding (and the larger organization within which it operates)
about the overall purpose of the team and the goals for each meeting.
Determine the composition of the team, including which disciplines are needed as members and
the number of members (enough to get the job done; not so many that the work cannot get done).
Allow the problem to define the composition of the team, not vice versa.
Determine how often the team needs to meet and specify attendance requirements (Is there a
core team of doctor, nurse, and social worker? Are other disciplines asked to participate on cases
that require their expertise?).
Identify time, place, and duration of team meetings.
Determine a system by which cases are to be presented and by whom. Identify how care plans
and action will be carried out and documented (Is one member chosen to write down the care
plan or does this responsibility rotate?).
Identify opportunities or requirements for team-building meetings and/or team training.
Create mechanism for enforcing both governance and behavior rules (if rules are made and not
enforced, the team can quickly become ineffective and be a negative experience for everyone
involved).
Clear communication of what is occurring and why it is necessary. The time spent with
participants clarifying rules and getting a commitment for involvement will prevent team problems
and support the development of an effective and efficient team.
TEAM BUILDING IS
Not a linear process
Can take 3-5 years with NO changes
22
Behavior rules and expectations are also needed for each team. They can include
some or all of the following:








Ensure clear understanding by all team members of what a collaborative team is.
Promote understanding and respect for others’ expertise.
Recognize the culture of the professions involved.
Learn how to articulate your information clearly to others (for example, client and patient mean the
same thing in different professional groups.
Share information and expertise openly.
Identify and follow a decision process when roles overlap.
Resist setting rigid boundaries on roles. Instead, promote effective ways of sharing responsibilities
and tasks.
Define acceptable behavior (for example, willingness to work with other professionals to develop a
care plan, active participation, respect for others’ roles).
Your Notes:
23
Workshop Schedule Day Two
9:00 am – 4:00 pm
October 14, 2009
Learning objectives : DAY TWO
□
□
□
□
□
9:00 am – 9:30 am
9:30 am – 10: 15 am
Identify skills of different individuals within teams
Articulate barriers that affect communication exchange
Demonstrate effective communication tools
Identify sources and types of conflict in teamwork.
Identify strategies for managing conflict within a team
Greetings and Introduction
Housekeeping & Structure of the Workshop
Team Roles and
Responsibilities
Leadership
10:15-10:30
Workbook Pages 26-33
Workbook Pages 35-37
BREAK
10:30-11:30
Communication
11:30 – 12:00
The Plan
Workbook Pages 38-44
Practice Plan Exercise Page 39
Lunch Break
12:00 pm – 1:00 pm
1:00 pm – 3:00 pm
Communication Skills Con’t
3:00 pm – 3:15 pm
BREAK
3:15- 3:45
Module Three
Workbook Pages 44-52
Workbook Pages 54-62
3:45- 4:00
Debriefing & Closure for day
Evaluation
24
MODULE TWO
Leadership, Communication and Conflict
Management
25
MODULE TWO
Table of Contents
Pages
Section 1:
Team Roles and Responsibilities …………………………………………
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Skills of different Professionals on Teams
Specific roles/skills of Team Members
Decisions, Power and Authority (Chart)
Influences on Team
What does an Empowered Team Look Like?
Power Types (Chart)
Resistance
Trust (Exercise)
Signs of Dysfunctional Teams
Key Components of Productive Teams
Leadership ……………………………………………………………………
1.
2.
3.
4.
27-34
35-38
Shifting Leadership roles
Team Based Leadership
Characteristics of a Leader (Chart)
Leadership Approaches & Roles (Chart)
Section 2:
Effective Team Communication …………………………………………….
38-41
1. Planning the Event
2. Techniques that Encourage Communication
3. Styles of Communication
Team Conflict …………………………………………………………………
1.
2.
3.
4.
5.
Conflict & Styles of Practice ……………………………………………………
1.
2.
3.
4.
5.
6.
7.
41-44
Team Responsibility
Healthy vs unhealthy Conflict (Chart)
Conflict Dynamics and Factors
Conflict Roles and Perceptions
Conflict and Resistance (Chart)
Self Assessment of Conflict
Strategies for Preventing, Reducing and Managing Conflict
Addressing Conflict (Team, Private and Personal)
Common Approaches Conflict Resolutions
Characteristics of Constructive Feedback
Conflict Management Techniques
Role and When to Use
26
45-53
Team Roles and Responsibilities
Many professionals and community members are not familiar with the education base, the roles, or the
range of functions of members of other disciplines. This lack of familiarity is due, in part, to the manner in
which each group is trained – a unique professional environment with its own language, terminology,
problem-solving methods, and professional behaviors. This approach to training coupled with a general
lack of knowledge leads to under utilization of skills and capabilities and to disputes about areas of
overlapping practice.
Reflect back to the opening of this workshop – what skills,
professions, experience, and knowledge does your team have
or bring?
Skills of Different Professionals on Teams
Team members from different disciplines bring a unique set of skills (Table) skills will overlap.
It is important to recognize that each profession trains its members in a culture that adopts a common
language, professional behaviors, values, and beliefs. When members of a team do not share a common
team vision and understanding, disagreements can arise. Most professionals do not recognize the
training of others and learn what other professionals do only after they are practicing as professionals.
TEAM
Lead
Investigator or
Research
researcher
Team
Health Care Physician
Team
Management Board
Team
Member
Funder
Community
or subject
Student
Project
Manager
Consultants
Educational
institute
Nurse
Social
Worker
Student
Patient
Outreach
CEO
Community
Suppliers
Individual
Patient
Family or
supports
Consultants
Funders
A team focus can identify the situation from the following perspectives:






Medical issues
Psychological/emotional issues
Social issues
Economic issues
Living conditions
Spiritual
27
Specific Roles/Skills of Team Members
Knowledge about the about the preparation, expertise, and scope of practice affects individual team
member performance, in that it can:
1. Reduce tension that occurs around who is doing what,
2. Help members accept role overlap as necessary and positive,
3. Foster positive views toward the efforts of several disciplines, and
4. Increase the ability to problem solve beyond a single discipline.
Your Notes:
28
Decisions, Power and Authority:
How are decisions made ? Provide examples of each
Consensus
Decision by
Non
Decision
Other
No
competition
Decision
Making
Methods
Minority
Rule
Autocratic
Autocratic
with Polling
Majority
Rule
Voting
Influences on Team









A clearly defined problem or issue
Agreement on who has responsibility for what
Agreement on procedures and methods to be used before discussion begins
Clarity about the level of authority
Effective communication
Effective means of recording & documenting
Appropriate team members
A method for building commitment and ownership of direction
Support from the organization to carry out the decision
29
Majority is
not always
RIGHT !
When to use consensus
1.
2.
3.
4.
When a number of options need to be explored and considered
When it is important to explore many facets of an issue
When the solution creates more problems
When the decision is final
What Does an Empowered Team Look Like?
















Have ability to speak for oneself
Stay focused on task and process
Clear on the “who, what, when, why and how”
Ability to restate
Ability to determine personal preference and state it before a team
Ability to distinguish facts from opinions
Ability to identify and name feelings (yours and others)
Low level of defensiveness as people question ideas
Willingness to listen: process others viewpoints
Commitment to finding the best options
Low level of competitiveness
Sufficient self-esteem to say NO
Ability to look for mutually supported alternatives
Listening for and synthesizing areas of agreement
Patience to hold back from premature decision making
Desire to try
Can a team agree to disagree and still maintain goal and
direction?
Your Notes:
30
POWER
Power Types
Real &
Appropriate
Misused
Role & Authority
guilt
Verbal
Overt
Or
&
Non
Verbal
expert
victim
position
position
selfesteem
competative
Covert
Explore with your Team what experiences you have had with power!
Your Notes
31
Resistance
Resistance to giving up
status of control &
power
What you would see
Overcoming
Detach from the team
Walking out
Blaming
Understand and discuss the
resistance openly
Saying too busy
Acknowledge feelings
Refusing to participate “or just doing
lip service”
Slow to do things,
suggest long debates
over pro/con “put off”
Threatening to quit
Having a rejection reaction “you didn’t include me”
Viewing team building and work as separate
Stating that team work is ‘to much”
Procrastinating
Discounting the roles & contributions of others
Recruitment and manipulation of team members
Actively or passively
sabotage the team
efforts
Saying too busy
Stating team building not part of “job”
Poison talk re: waste of time, team worse than
ever…
Undermining
Being negative – hopeless
“management will do what they want anyways”
Comfort members without
trying to fix their discomfort to
change
Anticipate and plan for
resistance
Convert the resistance to
positive
Educate – train individuals
Comfort members without
trying to fix their discomfort to
change
Discipline members and define
the consequences for lack of
collaboration
Promote gains & benefits for
the individual, the team and the
client
Attacking others
Using clients – members in the cause “well you
will have to ask or work with if you want to
continue”…
OTHERS?
“Synergy = when the team shifts from individuals to a entity that is greater than its parts”
Trust & Confidence
32
Team trusts is often based on whether we perceive a balance between what we
are giving to the situation and what we are getting from it”
Trust how do we gain it?
How do we lose it?
Signs that we don’t have it?
When team members are feeling a of lack of Trust this can lead to greater effort to gain personal
control
Your Notes
33
Signs of Dysfunction Teams
Lack of team vision, goals
and objectives
Not showing up & lack of
being involved in team
/workplace
team can't make decision
Lack of support from
management
Too many members
Hidden Agendas
Lack of buy in &
commitment
Lack of key members
Lack of clarity about
roles and responsibilities
Lack of
Leadership &
Direction
Splinter groups or cliques
Lack of training or
education for members
Incompatable polices,
procedures and decision
Anti - team culture & lack
of sharing
information/resources
Turfing & returning to silo
services
Not maximizeing the
skills of team members
team members lack of
willingness to cooperate
Team focus at the
expense of team
realtionship development
Key Components of Productive Teams





















Personal agendas are sidelined
Respect and flexibility
Culturally (lifestyle, spirituality, etc safe)
Shared vision and goals
Team climate is comfortable and empowering
Individual competition is limited
Open communication
Respect for diversity
Collaboration & open-minded
Strength based
Trust
Conflict and differences are considered “opportunities”
Team practices reflection of procedures, process, practices and experiment with changes
Regular meetings – that are clear, specific and time sensitive
Planning for and recognition of the impact of arrival /departure of team members
Orientation for new members
Opportunities for social and professional relationship & education development
Rotating leadership
Consensus decisions
Lack of service duplication
PERSON FOCUS
34
Leadership
The concept of different roles held by members of a interdisciplinary team is an
essential and very complex element of effective team function. Membership and leadership roles are
inseparable and involve an emphasis on role functions rather than on a particular discipline or a set of
personality traits. Success involves the effective utilization of a team’s total resources. Although one or
more individuals may have a formal designation as a group leader, the effective use of resources means
that all team members need to share responsibility for informal and formal leadership. In true interprofessional teams, the functions of leadership and membership are viewed as synonymous.
Shifting Leadership Roles on Teams



Collaborative teams demand equal participation and responsibility from all team members with
shifting leadership determined by the nature of the problem to be solved.
Even when one team member, has administrative authority over others (e.g., as supervisor),
members of a team treat one another as colleagues rather than as a single leader and
subordinates.
Emphasis by the team moves beyond the a narrow focus and broadens the roles and
responsibilities of team members.
Team Based Leadership













Every team needs a leader but not necessarily as a “BOSS”
Coach, Mentor, working member of the team
Keep the vision focus
Smooth out conflict
Mediates – in particular “turf” or “Silo” ing
Co-ordination of activities
Act as a liaison between team and community / systemic
Negotiate relationships
Identify gaps and resources
Obtain resources
Set and monitor milestones
Ensure member involvement, contribution and benefits
Keep work on track
35
Characteristics of a Leader - Add Yours
Respectful
Patient
Observant
Clear
Supportive
Assertive
Trusting
Enthusiastic
Knowledgable
Goal oriented
In a team situation the leadership must adopt a different
approach to management as:
1.
2.
3.
4.
5.
Most team members will not have direct reporting/accountability responsibility to the team leader
They have no compensational control
Can often have different “experiential” level from members
Does not have a “boss” authority
Are also a member of the team
Explore with your Team:
What experiences you have had with Leadership?
What worked? What didn’t?
What changed when you held the leadership role?!
36
However the leader is critical to team success and must adopt several roles to moderate the team.
Initiator
Model
Negotiator
•Role
•Relationships
Coach
Manager
Mediator
Your Notes
37
With your group complete the “plan the event”
exercise
Planning the Event
1. Each team will be provided with a scenario of a event or project they will have to plan
2. Each team member will be provided with a envelope with a description of their role in the team –
One person will be the observer
3. Each team member will also be provided with a sticker – you will take the sticker and turn to the
person on your right. Without showing the person the sticker you will place the sticker on their
hat/forehead/shoulder.
4. The person receiving the sticker cannot look at what the sticker says but others may view it
5. Plan you event (you will have 15 minutes)
Observer:
You will note the interactions between the team members and provide your feedbacks to the team at the
end of the exercise
Participants:
Pay attention to how you feel and perceive you are being treated during the exercise
38
Communication and Conflict Resolution
Effective Team Communication
To provide effective, coordinated services, a team must have an efficient
mechanism for exchange of information. At the simplest level, this requires the time, space, and regular
opportunity for members to meet and discuss patient cases.
An ideal system for team communication includes:




A well-designed record system.
A regularly scheduled forum for members to discuss client issues.
A regularly scheduled forum to discuss and evaluate team function and
development, and to address related interpersonal issues.
A mechanism for communicating with the external within which the team operates.
Effective communication relies on:




Listening,
Explaining perceptions,
Acknowledging, and discussing the differences and similarities in views,
Negotiating agreement.
The group process must integrate:



Openness and confrontation,
Support and trust, cooperation and conflict,
Sound procedures for solving problems and getting things done and good
communication.
Some barriers to effective communication and teamwork include:







Lack of a clearly stated, shared and measurable purpose.
Lack of training in interdisciplinary collaboration.
Role and leadership ambiguity.
Team too large or too small.
Team not composed of appropriate professionals.
Lack of appropriate mechanisms for timely exchange of information.
Time for meetings
The following tips will be helpful for valuing diversity on your team:






Reasonable people can—and do—differ with each other. No two people are the
same. Diversity among team members enhances creativity.
Learn as much as you can from others. Learning the various backgrounds,
cultures, and professional values of others can enrich your own skills and abilities.
Evaluate a new idea based on its merits. Avoid evaluating ideas based on who
submitted them or how closely they mirror your own personal preferences.
Avoid comments and remarks that draw negative attention to a person’s unique
characteristics.
Humor is a key factor in a healthy team environment but should never be used at
the expense of another’s identity or self-esteem.
Don’t ignore the differences among team members. The differences should be
honored and utilized to advance the goals of the team.
39
People do not need to think the same to be unified. The key to team success
is to value the differences on the team and use such diversity to achieve the
team’s common purpose.
Techniques that Encourage Communication
Types
Defining
Examples
Closed
Questions
Closed questions focus on specific problems
and elicit limited responses, often just a yes
or no.
Have you reviewed the patient’s
medications?”
Closed questions rarely elicit a lot of additional
information but they are appropriate when
specific information is needed quickly.
Open
Questions
Open questions give people permission to say
more about what they are thinking and feeling.
What else can you tell me about…?” “Can
you tell me more about…? “What are some
examples of the things you want to talk
about today?”
Minimal
Leads and
Accurate
Verbal
Following
Minimal leads indicate interest and encourage
people to continue talking.
Minimal nonverbal leads include head nodding,
eye contact, and leaning toward the speaker.
Accurate verbal following indicates
understanding
“Uhhuh.” “Umm.” “Hmm.” “Ah.”
Repetition
Repetition involves repeating one or two key
words from the person’s last sentence, which
indicates the team member is listening,
encourages people to keep talking, and
enhances their sense of being heard.
Repetition does not mean that one agrees with
another; it only means the person is listening.
Repetition is an important skill, but it should be
mixed with other techniques to avoid sounding
like a parrot.
Paraphrasing
and
Reflecting
When people paraphrase and reflect, they
repeat a person’s statement in their own words
to ensure that the message is understood.
40
Clarifying responses help people understand
the facts and the other person’s feelings and
attitudes.
Clarifying
Responses
“Is it possible that you feel…?” “Can you
give me an example of what you are
talking about?”
Clarifying responses also help people think
about what they have just said, examine their
choices, and look at their life patterns.
Confrontation
and Honest
Labeling
Confrontation and honest labeling are
techniques for gently exploring uncomfortable
subjects such as distortions of reality or
differences between words and actions. This is
not an angry demand that people confront any
subject.
Integrating
and
Summarizing
Integrating and summarizing help ensure that
the main concerns are understood. They help
team members clarify their thoughts and
feelings and encourage them to further
explore confusing and conflicting issues.
“I hear anger in your voice…” or “You
sound sad even though you say everything
is fine.”
Styles of Communication
DESTRUCTIVE
The Aggressor
The Blocker
The Withdrawer
Recognition
Seeker
Topic Jumper
Dominator
Can change depending on
topic , position of power
& authority.
Devil’s Advocate
CONSTRUCTIVE
Initiator
Information Seeker
Information Giver
Encourager
Clarifiers
Harmonizers
Gatekeeper
Your Notes
41
Conflict
Conflict does not stay private but will spill out into direct and indirect relationships. This will have short
and long term ramifications for the team and the clients in some situations conflict can expand to the point
of immobilization.
Team Responsibility












Open to difference & different ways of working
Listen to each other “actively”
Willing to understand difference of views even if do not agree
To question assumptions in a objective depersonalized manner
Look for opportunities to collaborate
Sharing your skills and knowledge
Develop working relationships getting to know at personal and professional (does not
meaning becoming best friends but understanding motivation and context)
Being committed and believing in the team and the goals
Being a reliable and trustworthy team member
Following up on commitments, promises
Being prompt and focused on task at hand
A team is made up of individuals and personalities with various degrees of needs/wants and
abilities – CONFLICT IS NORMAL and can be HEALTHY
What is identified sits above water
What is real is beneath
42
Elements That influence Conflict
Healthy Conflict
UnHealthy Conflict
•Work with more rather than less
information sharing
•Develop a debate including multiple
options, suggestions and opinions
•Rally around and actively work towards
goals
•Demonstrates healthy humor in the
workplace
•Issues discussed and resolved without
threat or forced consensus
•Maintained a team atmosphere and a
balanced power structure
•Shared work environment
•Other members sharing resources, time,
or space to team members who may
need …
•Team not individual focused
•A group sharing of credit
•One to one settling of differences
•Disagreements are de-personalized
•Understand that you do not have to be
“best friends” but respectful
•Individuals taking a glorified “lime light”
and credit for team work
•Over verbalization – talking over
•Rapid escalation of minor
disagreements
•Demanding of more resources
•Unwilling to share information
•Isolation (self or group imposed)
•Group / peer pressure to conform
•Team or individual aggressive behaviors
•Negative humor – unproductive
criticisms
•Double edged comments “underlying”
meaning
•Manipulative behaviors “trying to make
others look bad”
•Environmental changes “office, sitting
head of meeting table, office
arrangement”
•Cutting off members
•Closed door syndrome
•“not my job attitude”
•Developing cliques
•Intimidation
•Deflecting – “kitchen sink
Conflict needs to be broken down
- But maintain a sense of
Control
Independence
Competent
Inclusion
Belonging
Consulted
Equality
Recognition
Heard
What Motivates Conflict?
43
•Collaboration
•Information Sharing
•Lack of problem solving / decision
building skills
•Disagreements on priorities
•Power imbalances (discipline / roles)
•Differences in communication styles
•lack of clearly defined expectations –
agreements – responsibilities
Conflict Dynamics and Factors
Values
•Deserving
•Perception
•Emotion
•Options
•Choices
•Reaction
Fairness
•Power
•Status
•Processes
Authority
Roles and Perceptions

We feed the cycle
 Who we think we are
 Who we perceive others perceive us
 Those we fall into
 Who we want to be
Victim
•Absolving of
responsibility
•Blame Game, Not me
•Looks to others to fix
•Lack of control & power
“taken from”?
Fixer
IP
•Protector:
•Wants to please
everyone with the least
amount of anxiety
•Self- proclaimed or
ascribed, Power Struggle
with the “IP”
•Identified Problem
•Often a supervisor,
stereotype as having
control
•Common problem – goal
to address.
44
Resistance
Two forms of :
1.
2.
Active (Open refusal)
Passive (Non attendance)
INFLUENCES:
RESPONSE:
Emotions & Physical
Socialization
HABIT – Comfort Zone even chaos can be
comforting
Hierarchy – “Pecking Order”
Hurt when Hurt barriers
Power struggles
Nattering & Sabotage
Insider vs Outsider
Control
Assumptions of Role
Status
Discipline (profession)
Stereotype
Fight or Flight
Freeze
Passive
Silence
Closed Door Syndrome
Withdrawal
Resistance
Anger,
Mistrust,
Envy,
Fear,
Passivity,
Rigidity
Bullying
Shaking
Eye rolling
“secret” looks
Body Language
FEAR of :
Fear of the unknown
Fear of responsibility
Fear of failure
Fear of loss of control
Fear of rejection
Fear of success
Fear of change
Fear of abandonment
Three questions
1. What fears can we do something about?
2. What fears are beyond our control?
3. How will we let go of the ones out of our
control
45
Conflict & Styles of practice
Conflict is a natural and unavoidable part of human affairs, especially in such groups as
Collaborative teams that seek to grow and develop. The various individuals on a team have underlying
differences in their modes and methods of practice that affect their relationships with each other, as well
as with their clients.
This difference may be characterized by two different styles of practice.
1. One of these is “ruling out” problems by systematically eliminating possibilities until only one
problem and a corresponding solution remain. For example, physicians are trained in diagnostic
techniques that narrow the range of options, relying heavily on such objective data as laboratory
tests in the process.
2. The other approach of “ruling in” problems relies on expanding the range of professional view to
encompass an increasingly long list of potential factors. Social workers, on the other hand, are
taught to go beyond the narrow presenting problems to view it within larger, encompassing
psychosocial issues, such as income, family relationships, and environment.
Other factors that may lead to conflict in team care include


Scarce resources and
Organizational or professional change that threatens individuals or the overall program.
Reflect back to the stages of team development and the
influences that affect them
Intrapersonal: Interpersonal: Intra-group: Inter-group:
Each of these types of conflict influences the others, and team leaders will have to determine whether
and how to intervene when conflict occurs. Participation on an interdisciplinary team requires individual
professionals to relinquish familiar hierarchies and freedoms.
Self-Assessment of Conflict
Each individual has a personal way of handling conflict and an important aspect of managing conflict in
teamwork is gaining a self-awareness regarding each member’s way of handling differences between
themselves and others.
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

It is also important to ask oneself, “What experiences in my life affect my response to conflict?
How do I overcome my ‘natural’ conflict handling style if it is inappropriate in some situations?”
Perhaps a team member grew up in a conflictual family and tries to avoid battles at all costs.
Perhaps one thrives on argument. These styles need to be identified and recognized in how they shape
the team’s work.
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Reflection
What is your baggage?
What are your triggers? OR
‘He/she knows how to PUSH MY BUTTONS”
Strategies for Preventing, Reducing, and Managing Conflict
•If I close my
eyes it will go
away. I will be
on vacation ..
•LOSE/LEAVE.
Avoid
Withdrawing
Smoothing
•It is ok - you
are ok - I am
ok would you
like a coffee?
•
•YIELD /LOSE
•It is ok it was
not that
important to
me I will
make do with
half the
sandwich
•NEUTRAL
Compromising
Forcing
•If you don't
like it you
know what
you can do.
this is the way
it is
•Lets focus on ...
what can make
this work for -- What about
us
•WIN/WIN
Problem
Solving
•WIN/LOSE
Strategies for preventing, reducing, and managing conflict within an interdisciplinary team
practice include the use of one or all of the following:





Built-in process to review decisions, including review and definition of goals, the direction of the
team, and priorities
Role clarification through the discussion of such topics and knowledge base, professional
stereotypes, specializations, autonomy, competencies, responsibilities, and codes of ethics.
Examination of overlapping roles and renegotiation of role assignments.
Recognition of professional hierarchies and discussion of their impact on team functioning (status
and delegation of authority issues are a part of this activity).
Opportunities for improving inter-professional skills of team members teaching processes for
handling conflict.
“Using Conflict to Promote Interdisciplinary Problem Solving,” identifies various methods and strategies
for managing conflict along with the key variable of power. In interdisciplinary teams, there are different
sources of internal power (e.g., knowledge or tenure), so some members have more power than others
do. Mature teams and team members are able to select the most appropriate conflict-handling style for
the situation (Julia & Thompson, 1994).
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Successful resolution of conflict requires the
ability to communicate effectively, as well as to
confront issues, not people, focusing on the
search for win-win solutions.
Think BACK to your Team Vision, Rules and Expectations….. DID you include
rules on how conflict was to be addressed?
Your Notes
48
Addressing Conflict
Two approaches in addressing Conflict:
Open Team
Discussion
Often the starting point
Keep discussion
depersonalized
Private /
Personal
Discussion
Used for inter-personal conflicts
Can be guided by processess
Team Discussion:
Plan and identify possible “conflict” areas and brain storm solutions with as a team
Create an environment that supports discussion
Encourage discussion that “wants” the tough issues addressed
Acknowledge issue in an open fact based manner
Encourage specificity
Keep the discussion “de-personalized”
Do not assign blame or “point fingers” discuss WHAT not WHO
Encourage a discussion around the behavior and motivation rather than making assumptions
Leave the discussion with concrete suggestions, plan for improvement – not everything will have
an immediate solution
10. Give space and time to cool down and to enable a sense of control – it may be better to come
back to the discussion.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Private Levels:



Encourage members to address conflict at the one to one level
Provide format for dealing with conflict procedure/protocol
If members engage in public conflict – suggest individuals continue discussion in private “remind
them of the impact on team and clients”
Personal Level:
1.
2.
3.
4.
5.
Take the emotional temp. of yourself and others
Defuse
Separate “venting”
Put in time and space
Reflection before action
6. Separate the emotion – problem – process
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Your Role:





Ask Questions rather than provide answers
Assess motivation
Focus on the “task” or “concern NOT the individual
Trust but Verify
Pay Attention “Be present physically and mentally.
Listen
Ask/Clarify
Accountable
The
Conflict
Meeting
Agreement
Challenge
Explore
Focused
Common Approaches Conflict Resolution
Take the following actions to manage team









Welcome the existence of the conflict, bring it into the open, and use it as potential for change.
Separate the person from the problem in an effort to diffuse the emotional component of the
conflict by showing respect, listening carefully, and giving all parties an opportunity to express
views.
Clarify the nature of the problem as seen by both parties. Is this the real problem?
Deal with one problem at a time, beginning with the easier issues.
Listen with understanding (interest) rather than evaluation.
Use the communication skills of listening, reflecting, and clarifying.
Attack data, facts, assumptions, and conclusions but not individuals (e.g., “I Disagree with your
assumptions”).
Brainstorm about possible solutions.
Use objective criteria when possible.
o Invent new solutions where both parties gain.
o Implement the plan.
o Evaluate and review the problem-solving process after implementing the plan.
o Identify areas of agreement. Focus on common interests not positions.
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Characteristics of Constructive Feedback
Positive and
Negative
Timely
Easily Acted Upon
Given with
attention to
context and caring
Not based on
evaluative
judgements
Private
Motivated in a
positive way
Expressed fully
Checked and
clarified
Invited by the
recipient
Expressed directly
Conflict Management Techniques
Working with Differences
1. Questions to consider:
o What creates differences?
o What are the underlying factors that cause differences?
o How are differences played out?
2. Types of Differences: what people fight over:
o Information/facts
o Goals
o Methods
o Values
3. Underlying factors that cause differences:
o Different personal histories -- experiences that influence mindset.
o Varied access -- to same information.
o Perceptual differences -- perceptions become one’s reality.
o Role factors -- expectations and resources differ.
4. Stages of evolutions of differences:
o Anticipation -- know something will happen that will result in a dispute.
o Aware -- but unexpressed verbal differences to others.
o Discussion -- differences begin to emerge openly during discussions.
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o
o
Open dispute -- differences are sharpened.
Open conflict -- positions are locked in, often a win-lose mentality. Attempts are
made to undermine the other side.
5. Transforming conflict into a problem solving situation:
o Encourage differences to surface and be expressed.
o Listen with understanding rather that evaluation.
o Clarify the nature of the conflict.
o Recognize and accept feelings of the involved individuals.
o Explore who and how the decision will be made.
o Discuss ground rules for resolving differences up front.
o Attend to the relationship as well as the business.
o Create humane vehicles for communicating with others.
o Focus on content and processes issued at the same time.
o Explore ways to facilitate problem solving
6. Key summary points:
o People: separate people from the problem.
o Interests: focus on interests not position.
o Options: generate possibilities.
o Criteria: results based on mutually agreed standards.
7. Some Competencies that influence encounters with difference.
o Active listening.
o Suspending judgment.
o Attack problems not people.
o Identify, explore, and use resistance.
o Ability to disengage.
o Ability to bracket.
o Ability to manage emotions.
o Ability to depersonalize.
o Ability to alter behavior, context, judgments, interfaces, and communication.
o Grace in ourselves, faith in others.
8. Mediating differences -- varied roles of a facilitator.
o Working through differences involves creating mutuality and respect for opposing
positions and people.
o Engaging intense differences requires being adaptive, strong, and emphatic, while
not loosing track of issues and feelings.
o Creating common ground involves expressing relational energy in varied ways:
catharsis, catalyst, confronting, prescribing, and supporting.
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Role and When to Use
Catalyst
•Creatively sharing new
information (e.g.,
stories,examples).
•Helping others to see
things in new ways.
•Exploring alternatives.
•Organizing data into
information.
Catharsis
•Provides opportunity
to ventilate feelings
and common
emotions
•Clarify, restate,
paraphrase, and
reflect.
•Develops openness
and fruitful trust
levels.
•Lowers tensions and
anxiety.
Confrontation
•Directly challenging
the status quo.
•Gently but persistently
questioning the
underlying rationale.
•Keeping the focus on
the conflict. Maintain
the tension.
•Compare critical
positions and
assessments
(yours/theirs).
Prescription
•Occurs after
assessing/diagnosing
the situation.
•Recommends course
of actions or
previously discussed
options.
•Ask check out
questions: “Does that
make sense to you
Conflict Resolution Ideas:
 Place conflict within the context of agreements “place the disagreement in
perspective”
 Separate acceptable and unacceptable solutions
 Articulate underlying “needs” and “perspectives”
 Record agreements so they are not forgotten in the discussion
 Temporary time outs
 Ongoing check ins on the process
 Develop a team conflict and/or improvement plan
Your Notes
53
MODULE THREE
Elements that Bring the Team Together
54
MODULE THREE
Table of Contents
Pages
Team Meetings ………………………………………………………..
1.
2.
3.
4.
56-58
Meetings
Responsibilities
Facilitator Examples (Chart)
Facilitating meetings
Team Culture & Ethics ………………………………………………
59
1. Professional
2. Discipline Power and Hierarchy
Information Sharing & Confidentiality ……………………………….
60-61
Legislation ………………………………………………………………..
62
55
Team Meetings
Although team members work in many situations in which leadership roles and functions can be shared
and assumed, a critical arena for effective leadership is the team conference or meeting. Managing the
team meeting process in order to achieve the team objectives demands a high level of skill and should
not be taken lightly. The team coordinator or facilitator is responsible for moving the team efficiently
through the process of the team meeting to make sure that the work of patient care planning is
completed. Some teams rotate this leadership responsibility to ensure leadership and the associated
tasks are shared.
Meetings
1. Agenda
2. Structure
3. Action










Clear purpose and goal
Define step by step
Set time and limits
Discuss subject
Alternatives
Summarize
Agree – consensus
Action
Identify and assign tasks and steps
Set for follow up
Responsibilities
Team Leader/Coordinator:










Schedules, arranges, and conducts the meeting.
Prepares and distributes agenda before the meeting and ensures that agenda is followed during
the meeting.
Clarifies purpose and helps the team identify goals.
Ensures that all team functions are assigned to various team members.
Encourages everyone to participate throughout the discussion.
Summarizes and organizes the ideas discussed to gain commitment (with help of recorder).
Identifies common topics or subjects in discussion to maintain direction of discussion.
Asks questions to clarify comments and restates if members are confused.
Encourages team to finish each agenda item before moving on to the next.
Encourages the integration of new members.
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The Recorder
The Recorder has four major tasks during meetings:
1. Documenting the efforts of the group, including summaries of decisions, action items (or assigned
tasks), and deadlines.
2. Maintaining the group’s focus and direction.
3. Actively clarifying the group’s progress by using strategies such as summarizing and seeking.
4. Producing written summaries.
The Timekeeper:
1. Informing the group of the beginning time and ending time, allowing enough time for the members
to begin and come to an end to the discussion.
2. Indicating when the group is using more time than available on one issue and remind them of the
number of tasks and time remaining.
3. Helping the team use its time on issues on which the whole team is needed.
Facilitator Roles Dialogue Examples :
Get the meeting started.
Encourage communication and
involvement of all members.
Ask team members for opinions
and feelings to encourage
discussion
Ask for a summary of the
discussion.
Paraphrase what someone has
said to help members
understand each other.
Ask for specific examples to
improve understanding.
Clarify assumptions.
Ask for explanation in order to
eliminate confusion and
repetition
Probe an idea in greater depth.
Today we need to review__ patients/cases/clients. Are there any
urgent concerns?”
What are the ________ needs you see?”
What is your view of the family’s request?”
What are the care plan goals we have agreed upon? Can
someone summarize?”
“Are you saying that we need more information on _________?”
“Please give some examples.”
“Your recommendation assumes that the patient is too confused
to make an independent decision.”
“We keep avoiding a plan for this. Can someone suggest how we
should proceed?”
What are other ways to help Mrs. S stay at home.”
Suggest a break or rest
“Let’s take a brief break.”
Move the team toward an action.
“What should we do first?”
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Facilitating Meetings
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
Get the meeting started
Encourage communication and involvement of all members
Ask team members for opinions and feelings to encourage discussion
Ask for a summary of the discussion
Paraphrase what someone has said to help members understand each other
Ask for specific examples to improve understanding
Clarify assumptions
Ask for explanation in order to eliminate confusion and repetition
Probe an idea in greater depth
Suggest a break or a rest
Move the team toward action
Poll members
Encourage open-mindness
Recommend a process
Step out of the facilitator role
Stop discussion to focus on team feelings
Encourage greater participation
Reflect for the team what someone else is feeling
Get back on track
Surface differences of opinion
Check team progress
Encourage new thinking
Explore potential results
Test for consensus of the team
Handle consensus blockers
Move towards a decision
Agenda focus:
1) problem
2) planning
3) information sharing
Your Notes
58
The Ethics Culture of Team Care
Each of us has a internal set of values, beliefs and expectations. We also belong to various concepts of
groups, organizations, communities and affiliations. It is though identifying and developing a sense of
belonging with these organizations that we develop a sense of “culture”. Most people have layers of
culture each of which are fluid and become prominent depending on the situation.
Service providers are educated within cultures that pass on instructions and assumptions about how
services should be provided and who should receive it. It is a constant push and pull struggle in
collaborative team work to negotiate the territory between general agreement among the culture of the
professionals about goals of care and the specific perspective and what is the best outcome and for each
team members contribution to toward that goal. The culture is not just external, it is
also an internal task of members of the team, who have to negotiate agreement and
disagreement regarding expectations of team members concerning what the
person/community/project needs, how it should be provided, and who should
provide it.
Professional Cultures
Each of the cultures that influences collaborative team development, has its own
view of its responsibility toward the individual, project and the community 's responsibility. Much of the
energy in teamwork is about the interaction of team members the "shared constraints" of the individual
disciplines and the focus of all the disciplines.
Representatives of individual professions frequently have little understanding of the ethical commitments
of other professions or of the service that the other professions provide. Cultures of disciplines and
professions express some of the constraints that they impose on their members in ethical codes. Codes
also establish norms that can protect individuals. A code provides a window on, or a snapshot of, a
discipline's view of the situation, and of the discipline's understanding of its responsibility in responding to
that situation.
List different types of culture that you belong to… ie work culture!
What are some of the rules, expectations, group thinks that come along
with that culture.
Your Notes
59
What are Discipline Power and Hierarchy?






Professional Beliefs
Each profession has a discipline specific “world view & practice”
o values
o language “acronyms”
o problem viewing & solving
o common understanding
Socialization & education
Attitudes
Hidden curriculum
Scopes of practice
Information Sharing and Confidentiality
a) Information that must be shared is:
a. Required by law and related policy
b. To protect the health, safety, well-being of clients or others
b) Information that should be shared is:
a. Information necessary to support continuity of care, ITCP or quality of service
c) Information that should not be shared is:
a. Information that is not relevant to the case
b. Information that is not absolutely necessary to assist clients and fulfil job requirements
Discussion Questions:
What is your reference point for making that decision (i.e. organizational policy, legislation,
relationship with family or other service providers, etc.)?
How would the task of creating a joint plan affect information sharing? How did people decide with
whom they would share information or how much they were willing to share? Did it have anything to
do with the relationships people had with one other? With families and individuals? Did it have
anything to do with personal beliefs, values ethics, or legislation?
Confidentiality: Personal Reflection Questions
60
What are my personal
beliefs regarding
confidentuality?
What does my
professional code of
ethics say about
confidentuality?
What are the
organization's
requirements around
confidentuality?
How does the inclusion
of families, communities
impact confidentuality?
How do I incorporate all
of the personal,
professional and
organizational
requirements into
ethical practice?
Do the requirements
presents ethical
dilemmas or challanges
that impact my sharing
of information?
What is my
understanding of "need
to Know?
Where do I establish my
loyality ?
Who owns the material I
may gather?
Who do I owe a
responsibility of
confidentuaility?
Legislation, Policies and Principles Influencing Collaborative Team work
61
Ethics Board
TRI PARTI
Canada Health Act
Canada Information and Privacy Acts
Indian Act
Charter of Rights and Freedoms
Health Care (Consent) & Care Facility Admissions Act (HCCCFAA)
Adult Guardianship Act
Child, Family and Community Services Act
First Peoples’ Heritage, Language and Culture Act
Freedom of Information and Protection of Privacy (FOIPPA)
Health Act & Amendments
Mental Health Act
Venereal Diseases
Health Professional Act
Health and Social Services Delivery Improvement Act
Human Rights Code
Personal Information Protection Act
Patients Property Act
Professional Practice Standards
Professional Ethics Standards
Union Codes and Standards (Collective Agreements)
Individual Agency Mandates and Directives
Respect in the Workplace Policy
References
62
Drinka & Clark (2000). Health Care Teamwork: interdisciplinary practice and teaching. Westport, CT
Auburn House Publishing.
Farrell, M. P.; Schmitt, M.H. & Heinemann, G. D. (2001) Informal roles and the stages of interdisciplinary
team development. Journal of Interprofessional Care, Vol 15, NO. 3, 2001 Carafax Publishing
Gilbert, J., & Bainbridge, L. (2001). Interprofessional Education and Collaboration: Theoretical
Challenges, Practical Solutions.
Heinemann, G. D., & Zeiss, A. M., (2002). Team performance in health care: Assessment and
development. New York: Kluwer Academic/Plenum.
MCFD, 1997
Meads, G., Ashcroft, J., Barr, H., Scott, R., & Wild, A. (2005). The case for Interprofessional
collaboration: In health and social care. Oxford, UK: Blackwell.
Vancouver Coastal Health, 2006).
Way, D, Jones, L., & Baskerville, N.B. (2001). Improving the effectiveness of primary health care through
nurse practitioner/family physician structured collaborative practice. University of Ottawa.
Julia & Thompson, 1994
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