By Greg Hunter, RT (R) (T)
Beth Boynton, RN, MS
In the first two of the series of this article, we have tackled barriers to effective teamwork. In the first part, we said that attitudinal problems create a work environment that prevents interpersonal relationships to foster teamwork. In the second part, we have discussed hierarchical culture as a formidable barrier that prevents interdisciplinary teamwork and which favors physician-dominated groups. There are also organizational issues such as lack of knowledge and appreciation of the roles of other professions and lack of outcome research on collaboration. On this third of the series, we will discuss barriers to teamwork that manifest at the team and individual levels.
Barriers at the team level
There are times that in a given team, group dynamics do not produce the desired process to achieve positive patient outcomes. This is because well within the group itself, there are challenges that are needed to be overcome first.
An example is that which starts from ambiguous goals. Goals are the lighthouse of every team effort. It points all interventions to the right direction. Sometimes when objectives are unclear, interventions do not proceed as expected. Conflicts may also arise between members. For example, in an effort to stabilize heart rate and blood pressure in a heart failure patient, it can happen that blood pressure normalizes but heart rate remains abnormal. At this point, the team may be in a position of not knowing exactly how to proceed as one objective is met and the other is not. The cardiologist and pneumonologist may have conflicting opinions on which goal of care to work on first.
Another barrier at the team level is unclear leadership roles. Perhaps you have experienced being in a group with the ‘leader’ not leading as he should and one other member assuming the leadership role or is left in charge. The result is that other members ask, “Do we proceed as directed by the one in-charge or should we wait for the ‘go’ signal of the leader?” Sometimes, there are also instances wherein two or more members dominate the team, leaving other members at a loss who takes on the leadership role. At times this can be fine but, the real problem arises when their plans are in conflict with the others’. Teamwork ultimately cannot happen when interpersonal relationships among members are poor.
Team culture can also be a barrier if it is toxic in general or if there are any dysfunctional relationships on the team. If, for example one or two seasoned people have informal power over others or if there is any covert or overt bullying among the team members, this culture may inhibit others from contributing ideas or from performing their best. It is difficult to measure how destructive an unhealthy culture can be and the rippling effects of negativity can be disastrous.
Group size also matters. If the group is too large, that is, having many members, roles and interventions may be redundant, posing unnecessary risk and fatigue to the client. Information dissemination and communication may be more problematic. On the other hand, a very small group may result to over fatigue of members as they take on responsibilities more than they can handle. Too much workload can result to poor employee engagement, lack of time for skill enhancement and consequently to resignations. Teamwork is therefore also affected by group size.
Lack of commitment of team members hinders teamwork, too. This barrier can stem from apathy, lack of motivation and lack of positive reinforcement such as due recognition and financial rewards. When a member abandons his duties, interventions are stalled and transition of responsibilities to a new member can affect teamwork and may cause further delays.
Barriers within individual members
There are factors coming from individual members that prevent teams from working towards a common goal. Lack of communication skills for example can deter a member from expressing his opinions for the betterment of service or of improvement of group dynamics.
Another factor is having multiple responsibilities. Having multiple responsibilities divide a worker’s attention and focus. This may cause the individual to contribute less to achieve the goal. Furthermore it causes burnout. All these negatively affect teamwork.
Workers may also be in a position to distrust collaborative processes. This can be due to previous failures, lack of information or heavy reliance on traditional methods of promoting teamwork. Distrust makes workers hesitant to contribute to team effort.
Summary and conclusion
There are numerous factors that prevent teamwork and collaborative processes from achieving positive client outcomes and health delivery system. These are attitudinal problems, hierarchical cultures, organizational barriers as well as factors arising from the teams themselves and from individual members. Perhaps it is also noteworthy to mention that barriers at the team and individual levels will have influence on each other so unless these are adequately and efficiently addressed, institutional goals are hard to attain.
If you need help fostering teamwork, you may seek the help of service providers whose expertise is on process improvement and collaborative efforts. ManageUP is such provider and has streamlined strategies that will make your workplace a place where teams believe and achieve!