Organizational Barriers (Why Teamwork Strategies Fail – Part II)

By Greg Hunter, RT (R) (T)

      Beth Boynton, RN, MS


Teamwork is essential in the realization of institutional goals. More importantly, it is crucial in ensuring patient safety and improvement. Without it, the healthcare delivery ultimately fails. In the first part of the series of this article, we have talked about attitudinal problems as a big hindrance to proper teamwork. We have said that as much as people are diverse, so are their attitude towards work and co-workers.

While individual attitudes affect service, there are also certain factors within the organization that prevent collaboration among members of a team.

Organizational culture as a formidable barrier

1.  The hierarchical culture

The hierarchical culture tells us the in the workplace, there is the “us” and the “them”. The “us and them” way of thinking begets professional territoriality, with those in power saying, “This is what we do, decide on what’s best for everyone… they only follow.” Dauntingly, power issues weaken teamwork efforts. Hierarchical cultures make adopting common goals for teamwork a difficult endeavor.

Leveling the hierarchy to promote interpersonal relationship that fosters group dynamics is difficult to achieve probably due to malpractice and liability laws that focus responsibility on individuals as leaders, who are in most cases, physicians. We can inadvertently say that these laws encourage hierarchical culture where leaders’ proposed changes and solution takes precedence over that of the majority since in the end, if there would be lawsuits arising from their service, they suffer most of the consequences. The result is that they assert whatever it is that would protect them from such consequences and real teamwork becomes a thing of healthcare utopia, ideal but too hard to do.

2. Lack of regulations and reward systems that promote positive team culture

Hierarchical culture is further enforced by the lack of regulations and reward systems that support teamwork. Groups that work on a common goal are fleeting because there are no bylaws that regulate team development. After a patient case, or sometimes within the timeframe of a given case, members come and go. There is not much time to build trust and work relationship that can do wonders on patient outcome and service delivery. Also, the traditional “fee for service” system makes teamwork tougher to foster. At least at present, there has been a significant move towards managed care, but there is still a lot to be understood about the process and a lot to be done to get to regulate teamwork. As for remuneration, there is also lack of recognition and financial incentives to reward teamwork and collaboration. Oftentimes, only leaders are recognized putting efforts of non-leader members out of the limelight.

Other organizational barriers that do not favor teamwork

In our workplaces, teamwork does not work as it should because of organizational barriers. For instance, with lack of knowledge and appreciation of the roles of other members of the team, tasks cannot be effectively delegated to the right people. Failure in this area leads to burnout, much to the detriment of team achievement.

The need for teamwork is recognized by everyone, but the intricacies of putting it into practice that lead to positive results are unknown to most. “How exactly do we go about it?” you may ask. People tend to look at the senior management for answers, who may or may not have the right platform to address teamwork issues. Sometimes, the problem lies not on the existence of programs, but on how to take the matter up to senior management that is the challenge here.

You might have also been a part of a team-building effort…. probably attended at least two seminars on this matter. Apparently, efforts are few (if there are) to evaluate and measure the effectiveness of such training. Did the training help? How much improvement was there? What are the impacts of the seminars? Are there still areas for improvement? For how long were the effects felt? There is stark lack of outcome research on collaboration.

Financial constraints are a challenge, too. Unless teamwork is recognized as a priority agenda, funds go to projects that are ‘more important’. People tend to believe that teamwork programs can be developed just as easy as putting up a group. But it is not. Sometimes, it is really necessary to avail of professional services whose expertise is on fostering collaboration. Certainly, this area of process improvement needs adequate funding.

Barriers to teamwork abound in the healthcare system. In each area, there are issues that need to be addressed.

If you recognize any of the obstacles mentioned in this series, it is recommended that your organization undergo a reassessment of the need for teamwork and collaboration. If there is even the slightest urge for you to know more, contact us, we’ll talk; no commitments unless you say so.

We will tackle more barriers to teamwork on the third of this series. Watch out for it!



Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Karen Luxford, Dana Gelb Safran, Tom Delbanco DOI: 510-515 First published online: 17 May 2011

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