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evidence & practice / CPD / professional issues

LEADERSHIP

Promoting effective teamwork in the


healthcare setting
NS886 Ryan S (2107) Promoting effective teamwork in the healthcare setting. Nursing Standard. 31, 30, 52-59.
Date of submission: 21 October 2016; date of acceptance: 10 January 2017. doi: 10.7748/ns.2017.e10726

Sarah Ryan, Abstract


Nurse consultant in Patients require access to various healthcare professionals to manage their healthcare needs.
rheumatology, Haywood Most nurses work in a team established to provide optimum care for patients. This article
Hospital, Staffordshire and explores the stages necessary to develop an effective healthcare team and identifies the
Stoke on Trent Partnership attributes required for effective teamwork. These include: effective leadership, a shared mental
NHS Trust, Stoke on Trent, approach (a common understanding of the roles and responsibilities of all members of the team),
England respect among team members and shared training. Scenarios involving a rheumatology team
that includes the author are used to demonstrate how effective teams can be established in
Correspondence practice, and the benefits of effective healthcare teams to staff well-being and patient care.
Sarah.Ryan2@ssotp.
nhs.uk Keywords
healthcare teams, leadership, team behaviour, team building, team leader, team training,
Conflict of interest teamwork
None declared

Peer review Aims and intended learning Nurses and Midwives to their professional
This article has been outcomes practice (Nursing and Midwifery Council
subject to external The aim of this article is to improve the (NMC) 2015). The themes are: Prioritise
double-blind peer reader’s understanding of the attributes people, Practise effectively, Preserve safety,
review and checked required for effective team building and to and Promote professionalism and trust.
for plagiarism using enable optimal teamwork in the healthcare This article relates to The Code in the
automated software setting. After reading this article and following ways:
completing the time out activities you »» Nurses must work cooperatively to
Revalidation should be able to: practise effectively. This article explores
Prepare for revalidation: »» Identify the different stages in team the stages necessary to develop an
read this CPD article, development. effective healthcare team and identifies
answer the questionnaire »» Explain the role of the team leader, and the team attributes required to enable
and write a reflective the qualities associated with effective effective teamwork.
account: rcni.com/ leadership. »» It discusses various tools available to
revalidation »» Discuss how a common understanding of measure team performance. The Code
the roles and responsibilities of members states that nurses must work with
Online of a team can improve teamwork. colleagues to evaluate the quality of their
For related articles visit »» Explain the main behavioural patterns work and that of the team.
the archive and search and motivational systems that different »» It explores the leadership activities
using the keywords team members might have. necessary to lead an effective team
»» Outline the advantages of shared training during the planning and action phases of
for a team. a team’s development. The Code states
that nurses must identify priorities,
Relevance to The Code manage time, staff and resources
Nurses are encouraged to apply the effectively, and deal with risk to ensure
four themes of The Code: Professional the quality of care or service they provide
Standards of Practice and Behaviour for is maintained and improved.

52 / 22 March 2017 / volume 31 number 30 nursingstandard.com


»» It indicates that each team should consider are required for effective teamwork, To write a CPD article
the best ways for sharing information understanding behavioural patterns of Please email gwen.
and communicating. Ineffective individual team members, and the benefits clarke@rcni.com.
communication is associated with of team training. Guidelines on writing for
compromised patient care, staff distress, publication are available
tension and inefficiency. The Code states Tuckman’s model of team development at: journals.rcni.com/r/
that nurses must maintain effective Tuckman’s (1965) model is one of the author-guidelines
communication with colleagues and share most widely used to explain how a team
information to identify and reduce risk. develops. It is based on an examination
of 50 empirical research studies. It
Defining a team remains widely used in many settings,
A team consists of two or more people including healthcare, although it was
who work interdependently towards developed more than 50 years ago.
a shared outcome. The members of The model identifies three aspects that
a team may each have different roles determine how well teams perform
and responsibilities, yet they work in (Tuckman 1965):
a collaborative manner to achieve an »» Content – what the team does.
identified goal (Molleman et al 2010, »» Process – how the team works towards
Chen et al 2011, Kimble 2011). For its objective.
example, in rheumatology, the healthcare »» Feelings – how team members relate to
team might comprise various healthcare one another.
professionals, including nurses, Tuckman (1965) identified four stages
physiotherapists, occupational therapists, in the development of a team: ‘forming’,
podiatrists, pharmacists and doctors. ‘storming’, ‘norming’ and ‘performing’
Each member of the team has specialist (Table 1). He maintained that a team
skills and expertise, yet all members only becomes effective when it reaches
work together to achieve the optimum the performing stage, and that the time
health outcomes for the patient. taken for a team to move from one stage
McCabe (2006) related teamwork to a to another is influenced by the type,
4x400 metre relay, in which it is necessary composition and leadership of the team
for the athletes in the team to understand (Tuckman 1965). The model acknowledges
each other’s strengths and limitations to that some teams may never reach the
ensure the fastest runners are selected for performing stage. Some teams may never
the sprint finish. An effective healthcare progress beyond the forming stage, while
team has a co-ordinated approach to other teams will accept storming as their
patient care, with explicit and consensual usual way of operating, with constant
division of responsibilities, so that every challenges to authority. A fifth stage,
member of the team is aware of their role ‘adjourning’ or ‘mourning’ was added in the
and what is expected of them to enable the 1970s to describe a team that has completed
team to function in an optimal way (Vliet an identified task and has subsequently
Vlieland et al 2006). been disbanded (Tuckman and Jenson
1977). Tuckman’s (1965) model is useful
TIME OUT 1 for understanding the functional stage of
Draw a diagram of the structure and members of the team a team. However, further elaboration is
you work in. Identify the main relationships you have required to enable understanding of a team’s
with different team members. Discuss with a colleague dysfunctional phase of development, which
possible opportunities for strengthening the relationships occurs in the storming stage.
that you have identified. Make brief notes on your
discussion. Applying Tuckman’s model of team
Team development development to rheumatology practice
This article explores the stages in Patients with rheumatoid arthritis and
Tuckman’s (1965) model of team osteoarthritis have emphasised the need
development, the team attributes that for services to support them to manage the

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evidence & practice / CPD / professional issues

physical, psychological and social effects be expected to provide advice on exercise,


of chronic pain (Ryan et al 2013). In the or whether this was the remit of the
following scenario, a nurse-led chronic physiotherapist.
pain team was established in response to
this need, to provide a service, including Storming
education and support for patients with In the storming stage of the service, team
chronic musculoskeletal pain. members challenged some of the tasks
that the managers of the service outside
Forming the team had proposed the team should
In the forming stage of developing the engage in, for example providing ongoing
service, team members engaged in defining counselling for patients with psychological
what the service would offer to patients needs, since none of the nurses in the
and how the service would function, newly-formed team had any experience in
including the frequency of the service, this area. This led to interpersonal conflict
its location and duration, and length of between the managers responsible for the
appointments. They referred to similar service and nurses in the team, who had
services for guidance and direction on different expectations of what the service
how to set up the service. Team members would offer.
experienced anxiety about what their roles
would involve. For example, questions Norming
were raised about whether the nurse would In the norming stage of the service, there was
an open exchange of views between team
TABLE 1. Tuckman’s model of team development members. There was clarification about
which core services would be offered by the
Stages Content Process Feelings team, and how additional services such as
Stage 1: Team members Team members search Individuals feel anxious and counselling would be accessed from external
Forming engage in task- outside the team for unsure of their roles. agencies, including the voluntary sector. This
orientated behaviour. guidance and direction. sharing of ideas resulted in acceptance of
Stage 2: Team members There is confrontation Individuals feel uncertain the different roles that team members would
Storming challenge the from the team leader in their roles and attempt to undertake and the development of trust
rationale for the and team members express their individuality. between team members.
tasks the team has isolate themselves
been asked to do and from the activities of
Performing
their responsibility the team.
for them. In the performing stage of the service,
all team members were communicating
Stage 3: There is an open The team starts to Conflict is replaced with
effectively, comfortable in their roles
Norming exchange of views in set up procedures to trust and an acceptance of
the team about the manage their tasks. other individuals and their and working collectively towards a
team’s performance. roles in the team. Individuals common goal of supporting patients with
are clear about individual chronic pain to optimise their physical,
roles in the team. Individuals psychological and social functioning.
ignore individual differences
and feel more accepting of TIME OUT 2
each other.
Think about the team in which you work. What stage
Stage 4: Roles are effectively The team collaborates Team members share of Tuckman’s (1965) model of team development do
Performing integrated in the to achieve its tasks. a common focus, you think your team has reached? Discuss with a
team. Problem- communicate effectively, colleague what your team should do to move towards the
solving and goal- and become more efficient performing stage. If the team is at the performing stage,
orientated activities and flexible. Individuals how can you ensure the team continues to work at this
are apparent. feel a sense of belonging stage? Make brief notes on your discussion.
to the team. They feel more
proficient, and confident of
the capabilities of the team. Subsequent models, including the
transforming-performing-reforming model
(Tuckman 1965) (White 2009), have simplified the sequence

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of stages in Tuckman’s (1965) model of and to understand what each team member KEY POINT
team development, grouping the first three requires in terms of support and resources The leadership style
stages together as the ‘transforming phase’, to be able to achieve their goals. Some team used by the team leader
which denotes the starting level of the team. members may require clarification and is central to improving
This is followed by the ‘performing phase’ reassurance that they are ‘heading in the the effectiveness of
that describes the team working towards an right direction’, while other team members the team. Leaders who
identified goal, and the ‘reforming phase’, might require their contribution to be are transformational,
in which the team reaches a new level of acknowledged to re-energise their efforts empowering and
performance (White 2009). (Dow et al 2013). Leadership in healthcare communicate
should not be viewed as fixed, but rather positive support and
TIME OUT 3 as ‘co-produced’, with leaders and team encouragement to
Think about an effective leader with whom you have members working together to achieve agreed individual team members
worked. What was it about the leader that impressed goals (Carsten and Uhl-Bien 2013). have the greatest effect on
you? List the qualities you think make an effective leader. The leadership style used by the building and sustaining
team leader is central to improving the effective teams
Attributes required for effective effectiveness of the team. Leaders who (Wu et al 2010)
teamwork are transformational, empowering and
There are many attributes required for a communicate positive support and
team to work effectively. These include: encouragement to individual team members
leadership; a shared mental approach; the have the greatest effect on building and
‘3Rs’ – respect, reward and recognition sustaining effective teams (Wu et al 2010).
(McCabe 2006); and team training. The following scenario about
medicines management in the community
Leadership demonstrates the importance of effective
The type of leadership required to lead a leadership in the planning and action phase.
team differs according to the development
stage the team has reached. The work Medicines management in the
of the team can generally be divided community
into two phases: the planning phase Several nurses were concerned that if
and the action phase (Dow et al 2013). they reviewed a patient with an adverse
Leadership activities in the planning phase drug reaction while in the community,
include empowering and supporting they would not have immediate access to
team members to participate actively the medical support they received when
in reflection, reviewing past team conducting their clinic in the hospital
performance, developing goals and creating outpatient department. The leader of the
an implementation plan for the next stage. service development actively sought the
If the team does not consider the views of opinions and concerns of all team members
all of its members in the planning stage, about how this issue could be managed.
this is likely to result in suboptimal team The nurses involved in the service met and
cohesion and in the team goals necessary devised guidelines on how adverse drug
for the action phase being inadequately reactions would be managed.
defined (Larson 1999). The leader may also The leader was grateful for the clinical
use the planning phase to determine which input of the nursing team and made sure
team member is best suited to a specific the resources identified were provided,
role (Dow et al 2013). for example telephone access to a
Leadership activities in the action phase rheumatologist for guidance. The nurses
include providing organisational structure, were reassured that their concerns had
and managing internal and external been listened to and were acted on in the
resources to enable team members to achieve action phase of team development.
the goals identified in the planning stage
(Morgeson et al 2010). It is necessary for Shared mental approach
effective leaders to know the skills and A shared mental approach involves a
knowledge possessed by each team member common understanding of the roles and

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evidence & practice / CPD / professional issues

KEY POINT responsibilities of all members of the a meta-analysis of 72 studies, involving


A shared mental approach team, and is one of the main attributes 4,795 teams in a range of industries
enables recognition of required for effective teamwork in the (Mesmer-Magnus and Dechurch 2009).
the needs of other team healthcare setting (Burtscher et al 2011). A Ineffective communication is directly
members, enabling shared mental approach among members associated with compromised patient care,
individuals to identify of a team is often referred to as ‘being staff distress, tension and inefficiency in
changes in the clinical on the same page’, and can result in healthcare teams (Lingard et al 2004).
situation and adapt an understanding and appreciation of Each team should consider the best ways
their response, where individual team members, and how team to share information and communicate
necessary, to achieve goals can be achieved (Stout et al 1999). with each other. Regular team meetings
the desired goals. For Personal attributes that contribute to a can provide an opportunity for all team
example, if a team shares a shared mental approach and are evident in members to share their views, review what
commitment to reviewing effective teams include (Molyneux 2001): is working well and identify aspects that
patients on time in an »» Ability to delegate. should be improved. Other methods, such
outpatient clinic, other team »» Ability to compromise. as distributing a team newsletter, may
members can recognise »» Ability to maintain confidentiality. enable members to feel connected in large
when a colleague’s clinic »» Approachability. multidisciplinary teams, where it might be
is running late and offer »» Awareness of one’s strengths and difficult for the team to meet regularly.
their assistance, thereby limitations.
avoiding a long delay for »» Decisiveness. TIME OUT 4
patients waiting to be seen »» Effective organisation skills. List the different ways members of your team
»» Empathy. communicate with each other. Discuss with the team
»» Openness to learning. whether these means of communication are working well,
»» Patience. and identify ways communication could be improved,
»» Tolerance. or effective communication maintained.
A shared mental approach enables
recognition of the needs of other team The 3Rs: respect, reward and recognition
members, enabling individuals to identify For any team to work effectively, each team
changes in the clinical situation and adapt member should receive respect, recognition
their response, where necessary, to achieve and reward from the team, on a regular
the desired goals. For example, if a team basis. These are collectively referred to as
shares a commitment to reviewing patients the 3Rs (Box 1) (McCabe 2006).
on time in an outpatient clinic, other team
members can recognise when a colleague’s Strength deployment inventory
clinic is running late and offer their The strength deployment inventory is
assistance, thereby avoiding a long delay for
patients waiting to be seen. Salas et al (2005) BOX 1. The 3Rs: respect, reward and
referred to this as ‘backup behaviour’, where recognition
each member of the team has a sufficient
understanding of the roles of other members »» Respect – team members should feel respected by
to enable supportive action to be taken their colleagues, leaders and organisation. The team
as required. If a shared mental approach culture should foster trust and mutual respect among
its members.
is not evident in a team, then individuals
»» Recognition – team members should know that
are unlikely to be receptive to other team their contributions are recognised by the team and
members’ needs. This can result in each team their efforts are appreciated. This can be achieved by
member considering their own needs, with thanking them for doing an effective job.
no sense of collective responsibility to achieve »» Reward – team members require individual rewards.
the goals of the team. The specific nature of the reward depends on the
Sharing information between team motivational value system of each member. Some
people seek extrinsic rewards such as pay, while
members is an essential requirement for
others favour intrinsic rewards, such as a sense of
developing a shared mental approach achievement that they have supported others.
(Weller et al 2014). Sharing information
(McCabe 2006)
positively predicted team performance in

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an evidence-based tool that enables in their approach. It would be useful


exploration of the 3Rs. It was developed by to bear this in mind and ensure that
Ellis Porter in 1973, and uses relationship you allow enough time for the ‘green’
awareness theory to explain the premise individual to respond accordingly,
that people work effectively together when when requesting a decision from them.
they understand their own behaviour and This approach can enable individuals
that of their colleagues (Porter 1973). to begin to see the world through
The inventory enables team members to the eyes of their colleagues (McCabe
identify their own strengths, and increases 2006). Discussing the strength
awareness of how their behaviour might deployment inventory in teams can
affect other members of the team (McCabe increase understanding of the different
2006). The likelihood that conflict within value systems of individual team
a team will be reduced if a member of members. This can establish strong
the team relates to other individuals in a empathy in a group and encourages
way that respects the other individual’s a team culture where differences are
motivations. appreciated, respected and allowed for
The strength deployment inventory (McCabe 2006).
identifies three behavioural patterns »» Recognition – the team can discuss the
that reflect an individual’s underlying specific behaviours that motivate them
motivational values (Porter 1973): and those that disempower them in
»» Assertive-directing orientation (red) – the group exercises. This enables the group
individual’s sense of worth comes from to recognise the behavioural strengths
getting things done, achievement and and development opportunities in the
overcoming obstacles.
»» Altruistic-nurturing orientation (blue)
TABLE 2. Behavioural patterns and characteristics in the
– the individual has a high concern for strength deployment inventory
people and their welfare.
»» Analytical-autonomising orientation Behaviour Characteristics Motivational Traits
(green) – the individual has a pattern reward
requirement for order, self-dependence, Assertive- Demanding, Extrinsic »» Wanting to win so much that they
fairness and preservation of resources. directing competitive, rewards: public ‘step on the toes’ of others.
The characteristics and motivational orientation forceful, ambitious, accolades and »» Being in such a hurry to get things
(red) quick to act, awards. done that they disregard how
rewards associated with three behavioural
enterprising, others feel about things.
patterns of the strength deployment confident, assertive »» Being so sure they are right that
inventory (Porter 1973) are listed in and creative. they do not listen to the advice
Table 2. Healthcare professionals should of others.
also be aware of the traits associated with
these behavioural patterns (Table 2).
The strength deployment inventory Altruistic- Open, friendly, Intrinsic »» Wanting to help others so much
focuses on behaviour, values and rewards nurturing helpful, sincere, rewards: that they push their help on them.
(Porter 1973). It promotes the 3Rs in the orientation selfless, personal »» Wanting to maintain harmony, so
following ways: (blue) considerate, thanks. that they do not push for what
empathetic, they want.
»» Respect – the strength deployment
modest and »» Expecting that everyone is going
inventory promotes respect by supportive. to feel the same as they do.
understanding that different team
members have different behaviour Analytic- Cautious, precise, Prefer to be »» Wanting to be certain so much that
autonomising accurate, reserved, rewarded in an they delay reaching decisions.
patterns and character traits. For orientation principled, understated »» Being so concerned about what is
example, if you need a decision from (green) methodical, logical way, for right or wrong that they do not pay
a member of the team who has ‘green’ and fair. example for the attention to people’s feelings.
traits, then it would be unrealistic to quality of their »» Expecting that everyone will be as
expect an immediate decision because work rather concerned as they are with details.
the individual will want to check the than the results.
details and be thorough and precise (Porter 1973)

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evidence & practice / CPD / professional issues

KEY POINT team (McCabe 2006). The organisational support each other to maximise the team’s
Each professional group context in which a team operates has contribution to patient care (Weller et al
in a multidisciplinary team a direct influence on team effectiveness 2014). For example, in rheumatology, a
might often access team (Lemieux-Charles and McGuire 2006). team discussion about the clinical care of a
training and information »» Reward – the strength deployment patient newly diagnosed with rheumatoid
from different sources, inventory encourages individuals to share arthritis can help to clarify how the skills
thereby missing an which specific rewards motivate them and expertise of different members of
opportunity to understand (McCabe 2006). the team can best be used to optimise the
the roles and priorities of patient’s experience. If the clinician who is
different team members TIME OUT 5 diagnosing the condition is unaware of the
(Smith et al 2008). Such Using the strength deployment inventory (Porter 1973), role of the nurse specialist in supporting
segregation of training identify which colour matches your behaviour pattern and the patient to develop coping strategies
can result in different motivational rewards. Using the diagram of your team to minimise the effect of symptoms such
professional groups having that you created in Time out 1, identify three individuals as joint pain and stiffness, they might
different expectations in your team with whom you have an important working not consider making a referral to the
of how things should relationship. Mark the colour associated with each of nurse specialist. Discussing clinical cases
be done (Hudson 2002), them. Note down how your working relationship with at team training events also provides the
each team member could improve, now that you can
contributing to disharmony opportunity to develop mutual trust and
identify their way of working.
among team members increases awareness of individual team
when teamwork is Team training member’s contribution to patient care
required (Weller et al 2014) Each professional group in a (Weller et al 2014).
multidisciplinary team might often
access team training and information TIME OUT 6
from different sources, thereby missing List the features that can enhance team training
an opportunity to understand the roles activities, based on your experience of team training
and priorities of different team members activities and the information in this article.
(Smith et al 2008). Such segregation of
training can result in different professional Measuring team performance
groups having different expectations of Valentine et al (2015) undertook a
how things should be done (Hudson 2002), systematic review of instruments used
contributing to disharmony among team to measure team performance. They
members when teamwork is required identified that the most commonly assessed
(Weller et al 2014). Access to shared dimensions of team performance were
training for a team can minimise the effects communication, co-ordination and respect.
of hierarchical structures that often exist Few assessment tools have been directly
in the healthcare setting, which mean that linked to patient outcomes (Havyer et al
staff might feel that they cannot challenge 2014). However, there is evidence that
decisions made by more senior colleagues effective teamwork can have a positive
(Brindley and Reynolds 2011). Team- effect on patient outcomes in terms of
building events can provide the opportunity reducing pain (Castel et al 2013) and joint
to understand the needs and concerns of inflammation (Vliet Vlieland et al 2006),
different team members, and to devise a improving emotional and psychological
shared vision of the values and goals of the wellbeing (Castel et al 2013), and
team, enhancing team effectiveness. increasing survival rates and satisfaction
Team training using immersive simulation in patients with cancer (Davies et al 2006,
can be an effective tool to stimulate Kesson et al 2012). Instruments available
discussion about roles, responsibilities and to measure the performance of teams vary
sharing information in relation to patient in their behavioural processes and their
management (Weller et al 2014). Simulation ability to capture all stages of teamwork
involves the use of clinical cases to assist (Valentine et al 2015). Therefore, it is
healthcare professionals’ understanding of important to consider the conceptual
how different professional groups view a basis of the tool and the context in which
given situation, and how team members can it is being used, when selecting the most

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appropriate instrument to measure team increasing the opportunities for shared


performance. team training, team members can learn to
understand and respect how the individual
Conclusion contributions of team members can lead
Working in groups and teams in which to the team functioning in a collective,
there are different personalities and cohesive manner that benefits patient care
levels of self-awareness might affect the and improves team satisfaction.
cohesion of a team and can be challenging.
Relationships in the team can be enhanced TIME OUT 7
by awareness of the different behavioural Nurses are encouraged to apply the four themes of The
patterns of team members. This reduces Code (NMC 2015) to their professional practice. Consider
the likelihood of conflict occurring and how knowledge of effective teamwork in the healthcare
increases the likelihood of achieving the setting relates to The Code.
performing stage of Tuckman’s (1965)
model, at which teams become effective. TIME OUT 8
Effective leadership and a shared mental Now that you have completed the article, you might
approach among team members are like to write a reflective account as part of your
essential to enable optimal teamwork. By revalidation.

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(2013) Applying organizational science to effect of organizational culture on team
health care: a framework for collaborative a personal reflection. Musculoskeletal Care. Research. 36, 5, 555-599.
4, 2, 116-121. interaction and team effectiveness:
practice. Academic Medicine. 88, 7, 952-957. Smith AF, Pope C, Goodwin D et al (2008) team leadership as a medium. Journal of
Havyer RD, Wingo MT, Comfere NI et al (2014) Mesmer-Magnus JR, Dechurch LA (2009) Interprofessional handover and patient International Management Studies. 5, 2,
Teamwork assessment in internal medicine: Information sharing and team performance: a safety in anaesthesia: observational study 190-198.

nursingstandard.com volume 31 number 30 / 22 March 2017 / 59


evidence & practice / self-assessment questionnaire

Effective teamwork
TEST YOUR KNOWLEDGE BY COMPLETING SELF-ASSESSMENT QUESTIONNAIRE 886

 1. In Tuckman’s (1965) model of team development,  7. Which of the following is not one of the 3Rs team How to complete
at which stage does a team become effective? members require for a team to work effectively? this assessment
 a) Forming c  a) Respect c
This self-assessment
 b) Storming c  b) Reward c
questionnaire will help you
 c) Norming c  c) Reassurance c to test your knowledge.
 d) Performing c  d) Recognition c It comprises ten multiple choice
questions that are broadly
 2. What influences the time taken to move from  8. A characteristic associated with a person with linked to the article starting on
one stage to another in Tuckman’s model? an analytic-autonomising orientation is: page 52. There is one correct
 a) Leadership of the team c  a) Methodical c answer to each question.
 b) Type of team c  b) Considerate c »» You can test your subject

 c) Composition of the team c  c) Confident c knowledge by attempting


the questions before reading
 d) All of the above c  d) Supportive c
the article, and then go back
 3. In Tuckman’s model, three aspects determine  9. Which trait may be associated with an individual over them to see if you would
how well teams perform at each stage: content, with an altruistic-nuturing orientation? answer any differently.
process and feelings. In the process aspect of a  a) Being so sure they are right they do not listen »» You might like to read the
team’s performing stage: to the advice of others c article before trying the
 a) The team collaborates to achieve its tasks questions. The correct
c  b) Expecting that everyone feels the same as they do c
answers will be published
 b) Team members share a common focus,  c) Wanting to be certain so much that they delay in Nursing Standard on
communicate effectively and become more reaching decisions c
5 April.
efficient and flexible c
 d) Being so concerned about what is right or wrong
 c) Roles are effectively integrated in the team Subscribers making use
c that they do not pay attention to people’s feelings c
of their RCNi Portfolio can
 d) Problem-solving and goal-orientated activities
 10. Access to shared training for members of a team complete this and other
are apparent c
may: questionnaires online and save
 4. A leadership activity in the action phase is:  a) Result in different team members having different the result automatically.
 a) Empowering and supporting team members to expectations about how things should be done c Alternatively, you can cut
participate actively in reflection out this page and add it to your
c  b) Enable team members to understand and respect
professional portfolio. Don't
 b) Managing internal and external resources to enable the contributions of different professional groups
forget to record the amount
team members to achieve team goals c and individual team members c
of time taken to complete it.
 c) Creating an implementation plan c  c) Maximise the effects of hierarchical structures c
You may want to write
 d) Reviewing past team performance c  d) Hinder the team’s ability to support each other to
a reflective account based
maximise their contribution to patient care c
on what you have learned.
 5. Which personal attribute does not contribute to
a shared mental approach in effective teams? Visit journals.rcni.com/r/
reflective-account
 a) Ability to compromise c This self-assessment questionnaire was compiled by Beth Knight
 b) Impatience c The answers to this questionnaire will be published on 5 April
 c) Ability to delegate c
The answers to SAQ 884 on nurse-patient relationships, which
 d) Awareness of one’s strengths and limitations c appeared in the 8 March issue, are:
 6. A shared mental approach in an effective team is 1. b 2. d 3. b 4. a 5. b 6. a 7. c 8. b 9. d 10. c
not indicated by:
 a) Recognition of the needs of other team members c
 b) A sufficient understanding of the roles of others to
enable supportive action to be taken as required c
 c) Ineffective communication associated with tension,
inefficiency and compromised patient care c
 d) Sharing of information between team members c

60 / 22 March 2017 / volume 31 number 30 nursingstandard.com