Team Building in Healthcare and Nursing

The Team Building in Healthcare and Nursing. Understanding the four key types of teamwork activities (focused on communication, trust building, problem-solving, and decision-making) is critical to building a cohesive, high-performing team.

What is Team Building in Healthcare and Nursing

Teamwork in healthcare and nursing is essential for optimizing patient care and improving the overall healthcare environment. Effective teamwork improves communication, collaboration, and problem-solving, ultimately resulting in better patient outcomes and greater job satisfaction among healthcare professionals.
A strong team communicates effectively and frequently. Nursing staff must be able to collaborate internally and across disciplines. This unified approach benefits the organization and patients, as better communication reduces the risk of medical errors due to miscommunication.

Building And Managing Teams In Nursing

International evidence suggests that teams composed of various health-care professionals can maximize the strengths of health-care professionals, enhance work processes, and improve patient care outcomes (World Health Organization [WHO], 2010). The complexity of health care globally today requires a collaborative approach to ensure patient safety and quality care. Historically, nurses have been in the habit of working alone, developing plans of care without considering the patient and their family or other health-care professionals.

Nurses are called to provide patient centered care as members of inter-professional teams, emphasizing evidence-based practice, quality improvement approaches, and informatics (Cronenwett et al., 2007; Greiner & Knebel, 2003). Nurses must shift their mental models from working in silos to collaborating as members of the health-care team.

This post discusses teamwork and collaboration, including the stages of team development and the characteristics of an effective team. The role of nurse leaders and managers in fostering teamwork and collaboration is also covered. Knowledge, skills, and attitudes related to the following core competencies are included in this in this and next post: patient-centered care and teamwork and collaboration.

Teamwork And Collaboration In Healthcare and Nursing

Nurses at all levels must gain the knowledge and develop the necessary skills and attitudes to be able to collaborate on intra-professional and inter-professional teams. Teamwork and collaboration require “functioning effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (Cronenwett et al., 2007, p. 125).

Intra-professional teams are teams of nurses at various levels in the organization collaborating to ensure that patient care is continuous and reliable (American Association of Colleges of Nursing [AACN], 2008).When intra-professional relationships are strong, synergy is created, and nurses at all levels function as an efficient and effective team. Teamwork and collaboration are important to safe and quality care and a healthy work environment, whether nurse leaders and managers are building a team on the unit or across the organization.

Nurses at all levels must collaborate and function on various teams important to the overall goal of delivering safe and quality care. The American Nurses Association (ANA) and the American Organization of Nurse Executives (AONE) (2011) developed the document Principles for Collaborative Relationships Between Clinical Nurses and Nurse Managers that outlines the necessary principles for intra-professional teamwork and collaboration: effective communication, authentic relationships, and learning environments and culture.

Effective communication requires an understanding of the underlying context of the situation, an appreciation for the tone and emotions of a conversation, and accurate information. Principles include the following (ANA and AONE, 2011, para. 5–6):

• Engaging in active listening to understand and contemplate fully what is being relayed
• Knowing the intent of a message and the purpose and expectations of that message
• Fostering an open, safe environment
• Whether giving or receiving information, making sure that it is accurate
• Having people speak to the person they need to speak to, so the right person gets the right information Authentic relationships bolster the profession and the quality of care patients receive.

Nurses must cultivate caring relationships with each other similar to the nurse-patient relationship, by (ANA and AONE, 2011, para. 7–8):

• Being true to yourself and being sure that actions match words and that those around you are confident that what they see is what they get
• Empowering others to have ideas, to share those ideas, and to participate in projects that leverage or enact those ideas
• Recognizing and leveraging each other’s strengths
• Being honest 100% of the time with yourself and with others
• Respecting the personalities, needs, and wants of others
• Asking for what you want but staying open to negotiating the difference
• Assuming good intent from the words and actions of others and assuming that they are doing their best

A learning environment and learning culture support great nursing care and give nurses the satisfaction of knowing that their work is valuable and meaningful by (ANA and AONE, 2011, p. 9–10):

• Inspiring innovative and creative thinking
• Committing to a cycle of evaluating, improving, and celebrating, and valuing what is going well
• Creating a culture of safety, both physically and psychologically
• Sharing knowledge and learning from mistakes
• Questioning the status quo—ask “what if,” not “no way”

Nurse leaders and managers must be committed to maintaining a high level of staff involvement, which will enhance job satisfaction and promote staff retention. In turn, staff satisfaction has been attributed to reduced medication errors, decreased patient falls, and a decline in patient deaths (LeBlanc, 2014; Wessel, 2015). Inter-professional teams are teams made up of health-care professionals, the patient, and the patient’s family working together to collaborate, communicate, and integrate care to ensure that patient care is continuous and reliable (AACN, 2008).

Patient centered care is closely linked to teamwork and collaboration and requires health-care professionals to actively involve or give control to the patient and the family in all health-care decisions (Disch, 2012). Nurses at all levels must promote patients’ capacity for optimum involvement in their care and problem-solving (ANA, 2015). Further, nurses must establish partnerships with other health-care professionals on inter-professional teams based on the recognition of each profession’s value and contributions, mutual trust, respect, open discussion, and shared decision making (ANA, 2015).

Nurses at all levels have a responsibility to bring their unique nursing perspective to inter-professional teams to advocate for greater quality care and optimum patient out comes and to deliver evidence-based, patient-centered care (AACN, 2008). Teamwork is “sharing one’s expertise and relinquishing some autonomy work closely with others, including patients and communities, to achieve better out comes” (Inter-professional Education Collaborative Expert Panel [IPEC], 2011, p. 24).

Teamwork involves integrating the knowledge, expertise, and experience of health-care professionals to work collaboratively in planning and delivering patient-centered care that is safe, timely, efficient, effective, and equitable (IPEC, 2011). Functioning as an effective team member requires nurses at all levels to collaborate with other team members, patients, and their families, by using available evidence to inform shared decision making and problem-solving.

Inspired by a vision of inter-professional collaborative practice as key to safe, high-quality, accessible, patient-centered care, the IPEC identified four core competency domains of inter-professional collaborative practice (IPEC, 2011):

1. Values and ethics for inter-professional practice requires “working with individuals of other professions to maintain a climate of mutual respect and shared values” (p. 19).
2. The general competency statement reflecting roles and responsibilities is “use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served” (p. 21).
3. Inter-professional communication means “to communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease” (p. 23).
4. The general competency statement for teams and teamwork is to “apply relationship building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and equitable” (p. 25).

Collaboration is working jointly with others in a mutually beneficial and well defined inter-professional relationship to achieve common goals (Lukas & Andrews, 2014; Mensik, 2014). Collaboration is slowly becoming a reality in health care today. Research suggests that collaboration improves coordination, communication, quality, and safety of patient care (Robert Wood Johnson Foundation [RWJF], 2011).

Health-care professionals work together on a continuum that reflects the level of intensity in the working relationship (Lukas & Andrews, 2014). Cooperation is at the lower end of intensity and involves short, informal relationships in which the parties maintain their individual goals. Next on the continuum is coordination, which is longer term and involves planning and some shared resources and goals. The highest level of intensity is collaboration, which requires commitment to shared goals by all parties.

Collaboration uses the individual and collective skills and experience of team members, and it allows them to function more effectively and deliver a higher level of services than each would be able to provide alone (RWJF, 2011, p. 1). Teamwork and collaboration require nurses at all levels to use effective communication skills to collaborate and function on inter-professional and intra-professional teams. Nurse leaders and managers need to foster teamwork among staff members not only to improve patient outcomes but also to encourage growth both individually and as an organization (Hader, 2013).

Improving the use of teamwork and collaboration can benefit patients, staff, and the overall organization. Teamwork benefits patients by decreasing adverse events and increasing patient satisfaction. Nurses benefit from teamwork because it decreases fatigue and burnout and improves morale and work satisfaction. The organization benefits because satisfied patients and nurses decrease litigation and turnover as well as improve the organization’s reputation (The Joint Commission, 2012).

Cooperation Coordination for Team Building In Nursing

• Short-term
• Informal relationships
• Separate goals, resources, and structures
• Longer-term
• Some planning
• Division of roles
• Some shared resources, rewards, and risks Working together continuum.

Team Building

There is overwhelming evidence that the quality of teamwork and collaboration can determine whether a patient receives safe, competent, quality care in a timely manner (Wachter, 2012). As health-care organizations are faced with increasing demands for quality, as well as pressure to control costs and increase productivity, effective team building is an optimum strategy to meet these mandates. All nurses at all levels must engage in teamwork to collaborate with patients, families, and other health-care professionals to deliver safe and quality nursing care (ANA, 2015).

Nurse leaders and managers are critical to building successful and satisfying teams (LeBlanc, 2014). They must engage in teamwork as both team builders and team players and provide direction to enhance the effectiveness of the team (ANA, 2016). Effective team building encourages staff commitment, creativity, support, and growth of individuals, the unit, and the organization (Roussel, 2013). Teams are formed for different purposes.

The nurse leader and manager makes hiring decisions for the purpose of building the intra-professional nursing team for the unit. This team functions according to specific job descriptions and has clearly defined roles and responsibilities. The intra-professional nursing team provides specific services or nursing care depending on the unit or department. Committees are formal teams within the organizational structure. The types of committees used in an organization or unit are usually determined by the mission, vision, and philosophy.

Committees can be intra-professional or inter-professional. An example of an intra-professional committee is a nursing professional practice committee, which includes a registered nurse from all units or departments within the organization. An example of an inter-professional committee is a hospital ethics committee, which may include registered nurses from several units or departments, a physician representative, social workers, a chaplain, a patient advocate, other health-care professionals, and a health-care consumer (often a former patient).

Unit or department special task forces or ad hoc committees are formed to address a particular issue or project in a specific time frame. Members are designated by nurse leaders and managers and are given guidelines for the work of the team. Typically, a task force or ad hoc committee is time limited and includes several members who have expertise and/or interest in the special project.

An example of a task force is a team working on a quality improvement project. When building teams, nurse leaders and managers ask themselves several key questions (Mensik, 2014):

• What are the tasks the team needs to accomplish? Are the tasks new or have they been done before? Do the tasks require independent or interdependent work?
• Is representation from various levels of the organization needed?
• Is geographical, educational, and inter-professional diversity needed?
• What skill mix is necessary for the team to succeed? Does including team members with previous experience on successful teams help those members who do not have experience?

Finally, nurse leaders and managers should avoid asking the same reliable people to participate on teams. It may take extra effort, but encouraging new staff members to participate can bring new perspectives and avoid burn out among the more experienced staff members.

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