ZAGAZIG UNIVERSITY

FACULTY OF NURSING

MASTER DEGREE

SECOND TERM

TEAM BUILDING

UNDER SUPERVISION

Dr/ Aisha El-Sayed El-Araby

Dr/ Azza Abd-El Diem
PREPARED BY

Sara Hussien Salama

2019
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Outlines
- Introduction

- Definitions

- Types of team building

- Advantages of working in teams

- Disadvantages of working in teams

- Stages of team building

-characteristics of an effective team

- Responsibilities of team leader

- the nurse manager as a team leader
- Evaluating team performance
- the barriers to effective team.
- Conclusion
- References

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Objective
At the end of lecture the student will be able to;

- Define group, team, team building and team building activities

- List the types of team building

- List the advantages of working in teams

- List the disadvantages of working in teams

- Discuss Stages of team building

- List characteristics of an effective team

- Identify Responsibilities of team leader

- Define the nurse manager as a team leader

-Evaluate the team performance

-Discuss the barriers to effective team.

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Introduction

Most often, nursing occurs in a team environment. Work groups that

share common objectives function in a harmonious, coordinated,
purposeful manner as teams. The staff nurse is constantly involved in
teamwork. The nurse/aide/unit secretary team works together every day
on a nursing unit. With shared governance more often the norm and inter
professional team work common, the nurse may participate or lead a team
broader in scale than one unit. For example, a nurse might lead the acute
care practice council or be on a team to implement supplies at the
bedside.
High-performance teams require expert leadership skills. In a health care
delivery system integrated across settings, a team environment becomes
increasingly essential. Nurse managers must skillfully orchestrate the
activity and interactions of inter professional teams as well as con-
ventional nursing work groups. Understanding the nature of groups and
how groups are trans-formed into teams is essential for the nurse to be
effective.

Definitions

 A group:-

is an aggregate of individuals who interact and mutually influence each

other. Both formal and informal groups exist in organizations.

 Teams:-

are real groups in which individuals must work cooperatively with each
other in order to achieve some overarching goal. Teams have command
or line authority to perform tasks, and membership is based on the
specific skills required to accomplish the tasks.
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  Team building:-
focuses on both task and relationship aspects of a group’s functioning
and is intended to increase efficiency and productivity. The group’s work
and problem-solving procedures, member–member relations, and
leadership are analyzed, and exercises are prescribed to help members
modify their patterns of interaction or processes of decision making.

 Team-building activities:-
originally designed to improve interpersonal workplace relation-
ships, have expanded to include meeting goals and accomplishing tasks.

Types of teams

Three types of teams found in health care are:

1- Primary work teams

2- Leadership teams
3- Ad hoc teams
1- Primary work teams
Include all forms of operational teams, including patient care
teams such as a medical intensive care team and teams organized
by a focused area , such as the rapid response team or a quality
improvement team .
2- Leadership teams
The senior executive team is an example of an executive or
management – leadership team . At the hospital department level
there may be a leadership team that is composed of the nurse
manager , charge nurses and perhaps an educator.

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 3- Ad hoc teams
Project teams and problem solving teams are examples of ad hoc
teams found across settings and sites. Specific problem solving
teams in departments are other examples of ad hoc teams ,
frequently referred to as task forces.

Advantages of working in teams

 More input leads to better ideas and decisions.

 Higher quality output.
 Involvement of everyone in the process.
 Increased ownership and buy -in buy members.
 Higher likelihood of implementation of new ideas.
 Widens the circle of communication.
 Increased learning with shared information.
 Increased understanding of other people's perspectives.
 Increased opportunity to draw individual strengths.
 Ability to compensate for individual weaknesses.
 Provide a sense of security.
 Develops personal relationships.

Disadvantages of working in teams

 Requires more time.

 Can lead to many meetings.
 Often difficult to schedule mutual time.
 Requires individuals to give more of themselves.
 May take longer to make a decision.
 May be used as an excuse for a lack of individual effort.
 Personality conflicts are magnified.
 Disagreements can cause strained relationships.

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  Potential for subgroups to form.
 Teams can become exclusive rather than inclusive.
 May lead to unclear roles.
 " Group think " can limit innovation.

Stages of team building

1- Forming

In the initial stage, forming, individuals assemble into a well-defined

cluster. Group members are cautious in approaching each other as they
come together as a group and begin to understand requirements of group
membership. At this stage, the members often depend on a leader to
define purpose, tasks, and roles.

2- Storming

As the group begins to develop, storming occurs. Members wrestle with

roles and relation-ships. Conflict, dissatisfaction, and competition arise
on important issues related to procedures and behavior. During this stage,
members often compete for power and status, and informal leadership
emerges. During the storming stage, the leader helps the group to
acknowledge the conflict and to resolve it in a win–win manner.
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 3- Norming
In the third stage, norming, the group defines its goals and rules of
behavior. The group determines what are or are not acceptable behaviors
and attitudes. The group structure, roles, and relationships become
clearer. Cohesiveness develops. The leader explains standards of
performance and behavior, defines the group’s structure, and facilitates
relationship building.
4- Performing
In the fourth stage, performing, members agree on basic purposes and
activities and carry out the work. The group’s energy becomes task-
oriented. Cooperation improves, and emotional issues subside. Members
communicate effectively and interact in a relaxed atmosphere of sharing.
The leader provides feedback on the quality and quantity of work, praises
achievement, critiques poor work and takes steps to improve it, and
reinforces interpersonal relationships within the group.
5- Adjourning or re-forming
The fifth stage is either adjourning(the group dissolves after achieving
its objectives) or re-forming, when some major change takes place in the
environment or in the composition or goals of the group that requires the
group to refocus its activities and recycle through the four stages. When a
group adjourns, the leader must prepare group members for dissolution
and facilitate closure through celebration of success and leave-taking. If
the group is to refocus its activities, the leader will explain the new
direction and provide guidance in the process of reforming.

Characteristics of an Effective Team

1. Clear Purpose
The vision, mission, goal, or task of the team has been defined and
is now accepted by everyone. There is an action plan.
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2. Informality
The climate tends to be informal, comfortable, and relaxed. There
are no obvious tensions or signs of boredom.
3. Participation
There is much discussion and everyone is encouraged to
participate.
4. Listening
The members use effective listening techniques such as
questioning, paraphrasing, and summarizing to get out ideas.
5. Civilized Disagreement
There is disagreement, but the team is comfortable with this and
shows no signs of avoiding, smoothing over, or suppressing
conflict.
6. Consensus Decision
For important decisions, the goal is substantial but not necessarily
unanimous agreement through open discussion of everyone’s ideas
and avoidance of formal voting or easy compromises.
7. Open Communication and Trust
Team members feel free to express their opinions on the tasks as
well as on the group’s operation, coupled with a high level of trust.
Communication also takes place outside of meetings.
8. Clear Roles and Work Assignments
There are clear expectations about the roles played by each team
member. When action is taken, clear assignments are made,
accepted, and carried out. Work is fairly distributed among team
members.
9. Shared Leadership
Although the team has a formal leader, leadership functions shift
from time to time depending on the circumstances, the needs of the

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 group, and the skills of the members. The formal leader models the
appropriate behavior and helps establish positive norms.
10.External Relations
The team spends time developing key outside relationships,
mobilizing resources, and building credibility with important
players in other parts of the organization.
11.Style Diversity
The team has a broad spectrum of team player types, including
members who emphasize attention to task, goal setting, focus on
process, and questions about how the team is functioning.
12.Self-Assessment
Periodically, the team stops to examine how well it is functioning
and what may be interfering with its effectiveness.

Responsibilities of team leader

*Assign clear tasks to each member
*Regularly review and monitor progress of work
*Ensure that the team meets deadlines
*Discuss and agree on the timetable for major activities with the team
*Motivate team members
*Resolve conflicts
*Give guidance when needed
*Helps members to overcome barriers
*Regularly assess team performance using a checklist

The Nurse Manager as Team Leader

Because staff nurses work in close proximity and frequently depend on
each other to perform their work, the nurse manager’s leadership is vital.

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A positive climate is one in which there is mutual high regard and in
which group members safely may discuss work-related concerns, critique
and offer suggestions about clinical practice, and comfortably experiment
with new behaviors. Maintaining a positive work group climate and
building a team is a complex and demanding leadership task.

Communication
Communication is a central component of the nurse manager’s
leadership. The Joint Commission, the organization that accredits
hospitals, found that poor inter professional communication was the cause
of nearly 70 percent of unexpected events causing death or serious injury
(Joint Commission, 2011).
Effective nurse managers can facilitate communication in groups by
maintaining an atmosphere in which group members feel free to discuss
concerns, make suggestions, critique ideas, and show respect and trust.
An important leadership function related to communication is
gatekeeping, that is, keeping communication channels open, refocusing
attention on critical issues, identifying and processing conflict, fostering
self-esteem, checking for understanding, actively seeking the
participation of all group members, and suggesting procedures for
discussing group problems.

Evaluating Team Performance

The manager may be accustomed to evaluating individual performance,
but evaluating how well a team performs requires different assessments.
Patient outcomes and team functioning are the criteria by which teams
can be evaluated (Rosen et al., 2008). Outcome data, such as clinical
pathway information, variances in critical paths, complication rates, falls,
and medication errors, can help evaluate team performance.
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Group functioning can be assessed by the level of work-group cohesion,
involvement in the job, and willingness to help each other. Conversely
aggression, competition, hostility, aloofness, shaming, or blaming are
characteristics of poorly functioning groups. Stability of members is an
additional measure of group functioning.
Influencing team processes toward the attainment of organizational
objectives is the direct responsibility of the nurse manager. By
publicizing team accomplishments, creating opportunities for team
members to demonstrate new skills, and supporting social activities, the
manager can increase the perceived value of group membership.
Members of groups who have a history of success are attracted to each
other more than those who have not been successful.

Barriers to Effective Teams

The team may not share clear goals or purposes
Teams often face issues that can decrease the effectiveness of the
team and specifically its ability to make decisions: -
O The time trade-offs in decision-making (team decision-making can
take time away from working directly on projects)
O Problems of ‘groupthink’ and pressure to conform
O The potential for increased conflict over decision-making
O Group anxiety – concern about the reactions of other groups
members
O The potential for ‘hidden agendas’ and ‘blind spots’
Katzenbach and Smith (1993) list the following requirements for
building effective teams:
O Teams must be small enough in the number of members.
O Members must have adequate levels of complementary skills.

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O The team must have a truly meaningful purpose.
O The team must have a specific goal or goals.
O The team and members must establish a clear approach to the task.
O Members must have a sense of mutual accountability.
Without adequate team training and preparation, it is unlikely that
team(s) will work effectively to develop and realize a shared vision.
Without team leadership(as opposed to traditional top-down
leadership), teams will be unproductive.
Another potential barrier is individual resistance to working in teams
.

Conclusion

Whether a nurse is a leader , a manager , or a member of the team ,

effective performance requires commitment to the group. Forging new
relationships and strengthening old ones are typically facilitated by
deliberate actions ranging from creating clarity of purpose through
holding each other accountable.

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References
Sulivan,Eleanor J.(2011),Effective Leadership and Management in
nursing ,'Building and Managing Teams',eight edition,pp.(144-153).

Diane, L.(2011),Leadership Nursing Care Management,'Building

effecyive teams',six edition,pp.(350-355).

Geneva.(2007),World Health Organization ,'Team Building',pp.(8).

Manion.(2011),Team Building and Working with effective

groups,pp.(120-125).

Senn.(2000),Leadership and Management ,'Team Building',pp.(17-24).

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