Effective teams develop norms of conduct that lead to a common understanding that, in turn, anticipates needs and problems; and they use agreed-upon methods to manage situations—including those that involve conflict. Groups that are able to establish this will reflect a high degree of teamwork and robust communication.
Trademarks of a resilient team include working together to plan forward, reflect back, communicate clearly, and manage risk.
Salas, Sims, & Burke (2005) conducted an extensive review of the factors associated with team performance across a range of industries and proposed a model for five key dimensions of effective teams: team leadership, mutual performance monitoring, backup behaviors, adaptability, and team orientation. These five dimensions are founded on mutual trust, closed-loop communication, and shared mental models.
Shared mental models lead to a common understanding of the situation and of the plan for treatment and the roles and functions of the team members. This model is often described as being "on the same page" or "in the same movie." It enables anticipation of others’ needs, identification of changes in a situation, and adaptation of the plan. Without a shared mental model, the team members cannot fully participate in problem solving and decision making. Fundamental to developing a shared mental model is sharing information between team members. The shared mental model has been identified as a critical factor for effective teamwork in healthcare and prevention of adverse events.
The following video illustrates what happens when people do not have a shared mental model.
Notice that when the lighthouse finally added critical information, the ship changed course and avoided a collision. This is an example of adaptability. Only after several exchanges did the lighthouse speak up, perhaps because its culture and hierarchy created a hesitancy to speak up. Additionally, the captain displayed tunnel vision and lacked situational awareness. In this situation, mutual performance monitoring would have aided communication, so that a team member would advise the team of the lighthouse (and the risk, safety concern it posed) to make them aware of the situation and facilitate decision-making.
In a culture that promotes teamwork in the pursuit of safe, reliable, and effective care, team members are given permission to hold each other accountable across a flat hierarchy.
EXAMPLEA healthcare system implemented a structured communication tool, AIDET (five communication behaviors: Acknowledge, Introduce, Duration, Explanation, and Thank You), to speak with patients in an effort to decrease anxiety and increase engagement in their care. Each interprofessional healthcare team, including administrative and support staff, agreed on a mutually acceptable word they would use if they saw someone not displaying the proper behaviors surrounding AIDET. When the word was used, staff and clinicians acting inappropriately said the reminder made them aware of what they were doing and made them change behavior. People were uncomfortable at first using the word, but then it became a norm of conduct and was mutually respected by the team. This example again shows the important role of establishing a just and safe culture with psychological safety.
Achieving this level of teamwork requires team members to be committed, competent, self-managing, and courageous. Teams achieve the aforementioned characteristics only after regular practice. Organizations need to set expectations, and senior leaders should periodically do rounds and ask questions about the progress and status of the team such as the following:
Organizations need to also set the expectation that middle managers are responsible for establishing norms and adapting them to the work setting. Furthermore, they are responsible for providing psychological safety, ensuring the workload is evenly distributed, providing resources and support to the team, and managing any barriers or challenges that obstruct the team's ability to thrive and be effective.
Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM
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