LET’S DISCUSS

Inter-Professional Team

Collaboration

Team Dynamics

Team Dysfunctions & Challenges

INTER-PROFESSIONALITY

Process that professionals

develop ways of practicingOrganized to solve, explore a

variety of issues

Optimize client participation

Inter-professional practice

unique characteristics:

codes of conduct, values

ways of working

D’Amour, D. and Oandasan, I. (2005).

Nurse

Nurse Practitioner

Physician

Geriatrician

Physician Assistant

Social Worker

Psychologist

Psychiatrist

Pharmacist

Occupational Therapist

Physical Therapist

Speech Therapist

Chaplain

Dietitian

INTER-PROFESSIONAL GERIATRIC TEAM

http://www.youtube.com/watch?v=IqpT95TKumY&feature=relmfu

INTER-PROFESSIONAL COLLABORATION In the field of healthcare

effective collaboration and

interaction can have direct

ramifications for patient care

Poor teamwork skills in

healthcare have been found to be

a contributing cause of negative

incidents in patient care

A. It increases readmission rates to hospital.

B. It is physician-centered care.

C. It increases the cost of healthcare.

D. It improves the health of populations.

Which statement about inter-professional

collaboration is true?

D. It improves the health of populations.

Storming Norming Performing

Psychologist Bruce Tuckman (1965)

TEAM DYNAMICS

Forming• Members are positive and polite, excitement• Discussions about how the team will work• Anticipation and optimism • Pride in being chosen for the project • Suspicion and anxiety about the job • Tentative attachment to the team

• Leadership Style: DIRECTING

Storming• Stage when many teams fail• Try to focus on the job without support of

established processes • Defensiveness, competitiveness, disunity, and

increased tension or jealousy • Sharp fluctuations in attitude about the team and

the team’s chance of success • Questioning decisions and decision-makers

• Leadership Style: COACHING

Norming• Hierarchy established• Team members know each other better, may be

socializing, ask each other for help and provide constructive criticism

• Friendliness and trust towards other team members, confidence in the team goals, team cohesion and spirit, pride and sense of belonging to the team

• Leadership Style: PARTICIPATING

Performing• Hard work leads directly to progress towards

shared vision of goal• Being part of the team at this stage feels "easy"• Constructive self-change, sense of belonging• Understanding of each others strengths and

weaknesses• Self-organization of work

• Leadership Style: DELEGATING

Adjourning

• Termination of roles• Completion of tasks • Reduction of dependency • Process can be stressful • Perspective of the functioning group - this

fifth 'stage' takes us beyond that

5.

Inattention

to Results

4. Avoidance of

Accountability

3. Lack of Commitment

2. Fear of Conflict

1. Absence of Trust

Lencioni, P. (2002).

ABSENCE OF TRUST

Trust is the foundation

The absence of trust stems from team members’

unwillingness to be vulnerable in the group

For a high performing team to operate members

share successes and failures

share strengths and weaknesses

Lencioni, P. (2002).

About disclosure and not about confession

Overcoming the absence of trust requires:

Team members sharing experiences over time

Multiple instances of follow-through

In-depth understanding of unique attributes of

each team member

In building trust leader is most important

The leader must first demonstrate vulnerability

ABSENCE OF TRUST

Lencioni, P. (2002).

Team members must constructively

engage in conflict

Express themselves, know that they

have been heard, respected for their

thoughts and beliefs

Heart of how buy-in happens, when

skillfully handled conflict leads to

powerful commitments

The role of the leader: to surface

issues, perspectives, and opinions

FEAR OF CONFLICT

Lencioni, P. (2002).

Commitment is a function of two things:

CLARITY = removal of assumptions and ambiguity

BUY-IN = achievement of honest emotional support

Great teams make clear and timely decisions

Leave meetings confident no one harboring doubts

Achieve commitment engaging constructive conflict

Focus on problems not on personalized agendas

LACK OF COMMITMENT

Lencioni, P. (2002).

Dealing with objective issues precedence over ego conflict

Members express thoughts, beliefs creating buy-in & clarity

Once there is alignment and buy-in leadership teams drive clarity

Facilitated by the process of cascading communication:

taking key decisions and action items, ensuring a roll out that includes “why they are important”

LACK OF COMMITMENT

P. Lencioni, P. (2002).

Accountability

Leader holding their direct reports accountable

Peers holding each other accountable

Reminding each other

Commitments

Real or perceived breaches of performance

Behavioral agreements

AVOIDANCE OF ACCOUNTABILITY

P. Lencioni, P. (2002).

Leaders need to model accountability in a different way

Many shy away from dealing with inappropriate

behavioral problems

When leaders confront inappropriate behaviors they are

role-modeling accountability *sets the stage for peer-to-

peer engagement

AVOIDANCE OF ACCOUNTABILITY

P. Lencioni, P. (2002).

Two things get in the way of achieving results:

Self-interest

Self-preservation

Team members who put their individual needs or the

needs of their department above the collective goals

make it difficult to achieve better overall results

Overall team performance should come first

Need connection between self-interest & getting results

INATTENTION TO RESULTS

P. Lencioni, P. (2002).

The distractions from collective results are:

1. Personal ego

2. Career development

3. Compensation

4. “My department”

INATTENTION TO RESULTS

P. Lencioni, P. (2002).

The role of the leader sets

tone for the focus on results

If team members sense that

the leader values anything

other than results, they will

take that as permission to do

the same for themselves

INATTENTION TO RESULTS

Lencioni, P. (2002).

There are five common pitfalls make up team dysfunction

Interrelate and build off one another

Either significantly hamper the success of a team or

paradoxically become foundation for crystallizing to

achieve great results

INTER-PROFESSIONAL TEAM DYSFUNCTION

Testing and Developing

Understanding one’s professional identity

Likely role within a team

Ideas about related health professionals

INTER-PROFESSIONAL TEAM CHALLENGES

Invalid assumptions:

May lead to breakdown in

communication + teamwork

May constitute barrier to effective

care

Research suggests:

Students rate communication +

teamwork skills positively

Were favorable about inter-

professional learning

INTER-PROFESSIONAL TEAM CHALLENGES

SUMMARY

When teams build trust and engage in

constructive conflict then there is the

potential for building commitment and

accountability

Then the team can focus on meeting

and exceeding the goals and mission

Lencioni, P. (2002).

REFERENCES

P. Lencioni, The Five Dysfunctions of a Team- A

Leadership Fable (Jossey Bass, San Francisco, 2002).

D’Amour D & Oandasan I. (2005). Interprofessionality as

the field of interprofessional practice and

interprofessional education: An emerging concept.

Journal of Interprofessional Care. 19 (Supplement 1):8-

20.

http://www.youtube.com/watch?v=IqpT95TKum

Y&feature=relmfu