Team Building, Part 2
Google’s research into team functions are available for public access. In their discussion on team effectiveness, they start by citing a literature review from 2001 by Kozlowski and Bell. Although lengthy, these authors did make several points about understanding what is known concerning team building. I have extracted comments from their paper with a focus on team building in a medical context.
First, all medical teams are complex.
“Complex teams are characterized by (1) tasks that are externally driven, dynamic, and structured by explicit workflows; (2) common goals that necessitate specific individual contributions that may shift over a work cycle; (3) roles that are specified and differentiated such that they required specialized knowledge and skill; (4) a process emphasis that focuses on task-based roles, task interaction, and performance coordination; and (5) performance demands that require coordinated individual performance in real-time, the capability to adapt to shifting goals and contingencies, and a capacity to continually improve over time.”
Medical organizations often fail to recognize fully all these dimensions, and often tend to think of the issues in terms of individuals and individual performance. Yet to be effective, medical teams must address all five aspects of team process to deliver reliable, consistent medical care.
Of course, teams are made up of individuals, so much attention has been directed toward issues of team composition and what determines success. Summarizing this literature Kozlowski and Bell note: “Research has found that team-level conscientiousness is more strongly related to effectiveness for performance and planning tasks than it is for creativity and decision-making tasks.”
Most of the time, medical teams are trying to execute tasks, so conscientiousness is an important trait. But what about when groups of clinicians gather to solve a given patient’s problem? Clapp and associates addressed this issue in “The Stranger Effect—A Look at Interactions Between Consultants and Care Teams Through the Lens of Social Science.” They ask:
“In some cases, would it be advantageous to limit the contribution of a consulting physician to performance of well-practiced procedures like intubation or dialysis? In other cases, would the consultant’s distance from the case enable a fresh perspective leading to improved problem solving? Do unrecognized social dynamics sometimes inhibit the consultant from applying other expertise that could significantly improve a patient’s outcome or better align care with patient desires…
Encounters between consultants and teams are shaped by a dizzying mix of factors, including the medical situation, how it is understood by both consultants and teams, how the team relates to consultants from particular specialties and how those specialties relate to teams, the history and composition of the team, and the institutional norms of specific health care settings.”
As posited in this article, the consultant, the stranger, is analogous to the new person who has been hired to join the team already in place. Kozlowski and Bell note:
“Existing teams are governed by a relatively stable set of norms, role expectations, and shared systems of knowledge and meaning (e.g., group climate, mental models). These informal structures emerge through social and work-based interactions among members across a group’s developmental history. Newcomers present a potential challenge to this stable structure and are thus subject to efforts by group members to assimilate the person to it. At the same time, newcomers are confronted by a novel and ambiguous social and work context. While they want very much to “fit in” and “learn the ropes” and are generally prepared to accept guidance from the group, they may also seek to have the group accommodate to their needs, values, and capabilities. Thus, work group socialization is a process of mutual influence in which newcomers attempt to reduce uncertainty by learning about the work and group context; guided by group members who facilitate assimilation to existing norms, expectations, and meaning systems; while at the same time newcomers attempt to exert influence on the group to accommodate to their unique attributes and needs.”
The short hand term for these informal, often tacit, expectations is “culture.” Every medical team or unit has its “way we do things around here.” Most organizations have an orientation process: “Organizational factors were of lowest priority. …supervisors and social learning in the group context were the most effective newcomer strategies for learning about the role and group.”
Small group leadership matters. But acculturation is a dynamic process with several stages, which is rarely recongized.
“In phase 1, individuals are focused on resolving their fit in social space through a socialization process. This yields outcomes of interpersonal knowledge and team orientation, providing a foundation for shared norms, goals, and climate perceptions. In phase 2, individuals focus on acquiring task knowledge via skill acquisition processes with outcomes of task mastery and self-regulation skills. In phase 3, the level shifts to dyads that must negotiate role relationships, identifying key role sets and routines to guide task driven interactions. In phase 4, the level shifts to the team as it creates a flexible network of role interdependencies that will enable continuous improvement and adaptability to novel and challenging demands.”
This model emphasizes that socialization must occur before the newcomer can focus on acquiring mastery of the required tasks. Too often we assume possession of a diploma and license means you have mastered the task, which ignores the fact that medical work occurs in an organizational context. Opportunities to improve team building then include focusing on the details of the inculturation process in specific units, with attention to leadership development. In the next article we will consider cognitive models of team building.
18 March 2018
 https://rework.withgoogle.com/ Accessed 14 March 2018.
 Kozlowski, S. W. J. & Bell, B. F. (2001). Work groups and teams in organizations. Retrieved 14 March 2018 from Cornell University, ILR School site: http://digitalcommons.ilr.cornell.edu/articles/389/html.
 Ibid., p. 10.
 Ibid., p. 14.
 Clapp JT, Diraviam SP, Fleisher LA. The “Stranger Effect”—A Look at Interactions Between Consultants and Care Teams Through the Lens of Social Science.” 27 December 2017. Accessed https://catalyst.nejm.org/stranger-effect-interactions-physician-consultant-care-teams/html.
 Kozlowski and Bell, p. 17.
 Kozlowski and Bell, pp. 22-23.
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