1. Reading Early Warning Signs of HIT Team Failure
Working in Teams
Barriers to Success:
Reading Early Warning Signs of HIT Team Failure
Welcome to Working in Teams: Barriers to Success: Reading Early Warning Signs of HIT Team Failure.
This material (Comp17_Unit10) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Recognize key signals of team failure.
Barriers to Success: Reading Early Warning Signs of HIT Team Failure Learning Objectives
Recognize key signals of team failure.
Use appropriate response mechanisms to address team dysfunction.
Facilitate consistent scanning for symptoms of potential team failure.
The Objectives for Barriers to Success: Reading Early Warning Signs of HIT Team Failure are to:
Recognize key signals to team failure.
Use appropriate response mechanisms to address team dysfunction.
Facilitate consistent scanning for symptoms of potential team failure.
To have success in a health care environment, work and goals need to be met by various individuals working in teams. As Patrick Lencioni in his book, The Five Dysfunctions of a Team: A Leadership Fable asserts, it is not finance, not strategy, not technology, but teamwork that remains the essential ingredient in business success. This author insists that teamwork is rare and powerful, therefore, those who have teams that are high performing are those who are the, “winners.” Up to this point we have talked a lot about the characteristics of high performing teams. In this unit, we will begin to identify the signals of dysfunctional teams, discuss appropriate strategies to address team dysfunction, and review the impact of interventions that successfully reverse team dysfunctionality.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

3. Five Key Questions Living up to their full potential?
Meeting the expectations of key stakeholders in the organization?
Making any substantial progress toward strategic goals?
Causing low employee morale throughout the organization?
No luck in getting team to work together?
On this slide, you will see five questions. Answering these questions is a first step in determining the level of functionality in your team.
Do you feel that your team members are living up to their full potential?
Is your team meeting the expectations of key stakeholders in your organization or do you have the sense that the stakeholders are unsatisfied or unhappy?
Do you feel like it is very difficult or impossible to make any substantial progress toward your strategic goals?
Is an unproductive, conflict-ridden team negatively impacting employee morale throughout your organization?
Do you feel like you are banging your head against the wall and trying everything conceivable to get your team to work together as a cohesive unit with little or no success?
It should be pretty obvious what the answers to these questions will be if you have a low performing team. If they are not living up to what you know they could be or if morale is slipping or the team seems to be mired in one place and not making progress, then it may be time for an intervention such as reforming or repositioning of the team.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

4. Team Dysfunction
Dysfunctional Team: A team that distrusts other team members, lacks commitment, accountability, and shared goals. Patrick Lencioni – “The five dysfunctions of a team: A leadership fable”
According to Lencioni, human beings are fallible and imperfect, therefore are naturally dysfunctional. He also makes the point that all is not lost and despair is not the order of the day. Instead, he asserts that overcoming the normal human tendencies of dysfunctional behavior takes hard work. Self-awareness is imperative and it takes true effort to change bad behaviors within ourselves first, before we can impact others. He defines the dysfunctional team as one that distrusts other team members, lacks commitment, lack accountability, and does not share a common goal. Lencioni speaks to the all-too-human tendency to allow bad behaviors to fester, leading to team corruption and dysfunctional internal politics. This author’s work has gained wide recognition, not only for his frank appraisal of the issues of dysfunctional teams, but also in his strategies for remediation. Let’s continue with a discussion of some of those strategies.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

5. Are We Really a Team? Lencioni’s two fundamental questions:
Set aside personal goals
Egos go in the freezer
Team for team’s sake
Are we ready for heavy lifting?
It takes sacrifice & commitment
In his book, The Five Dysfunctions of a Team, Lencioni asserts that there are two fundamental questions that should be asked before any team building effort. The first is, are we really a team? We often know that teams are assembled to address a pressing issue or to rally around a common cause. But, does that really make a team? Do people who happen to report to the same manager, but have independent goals and missions constitute a true team? No. Recall the dimensions of a true team: common goals, determination, drive, and determination.
Sometimes there may be a team within a team, so that those who are not on the team for the right reasons (meaning those who are told to attend or are not engaged or passionate about the effort) often drift to the edges, and the core work is picked up by the internal team.
The point here is that the team needs to look at its self hard, and honestly, and decide if they are a team or just a group. Lencioni believes that it is much more efficient to not try to be something you are not, in other words, don’t waste effort on pretending you are a team. Acknowledge it, and move on.
The second question he asks that a team must ask itself is, are we ready for heavy lifting? High-performing teams are powerful, but it takes commitment, effort, and sacrifice. If the team is not ready to give it their all, shortcuts are often taken, morale drops, and resentment grows. It is best that everyone on the team understands this at inception.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

6. Causes of Team Dysfunction
Absence of trust
Fear of conflict
Lack of commitment
Avoidance of accountability
Inattention to results
Here are Lencioni’s five top causes of team dysfunction he describes in his book. Have you ever been in a team where these behaviors were experienced or demonstrated? One member of the team distrusts another, people are conflict avoidant, there is a lack of attention to results, avoidance of accountability, and a lack of commitment. Let’s talk about each separately since their identification is important and the strategies to deal with them are varied.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

7. Team Dysfunction: Absence of Trust
Individuals are unwilling to admit their mistakes
Team members are reluctant to let down their guard with one another
Team members who throw another “under the bus”
Self preservation—looking out for number one
Absence of Trust develops when team members hesitate to be open with one another or admit their errors, struggles, or needs. Trust is absolutely foundational to a team, therefore, if you do not have trust, there is no way you can have a team that will be able to perform. An example may be when the unit staff all agree to approach the manager in regards to issues with his behavior – they all come in and sit around a table, the spokesperson reveals to the manager the issue of concern, and then the rest of the team fails to speak up. In essence, the spokesperson has been betrayed by the rest of the team—and has been “thrown under the bus.” This type of trust destruction is very difficult (if not impossible) to repair. Finally, self- preservation—where team members are bent on looking out for number one—is another sign of a team slipping toward being dysfunctional.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

8. Team Dysfunction Fear of conflict: Lack of commitment
The team is incapable of engaging in healthy debate
Lack of commitment
Difficult for team members to commit to decisions
Lack of accountability
Teams don’t commit to a clear plan of action
Inattention to results
Team members tend to put their needs ahead of collective goals.
Dysfunctional teams fear conflict. They cannot share honest opinions or emotions without fear of retaliation, so natural, healthy conflict devolves into passive- aggressive efforts to manage anger. Without open debate, the team cannot trust or assess information, resulting in ill-advised choices and actions.
Teams that have a lack of commitment cannot fully invest in the team's decisions, cultivating an uncertain environment. Lacking direction and full engagement in the team's work, members often experience dissatisfaction.
When teams don't commit to a clear plan, accountability suffers. If action items and responsibilities are not defined, the group's goals become unclear, and members find it difficult to trace or uphold accountability. From the very beginning of the forming of the team there needs to be specific agreed upon ground rules, an action plan, meeting times, and deliverables across the entire team. If the team veers off the agreed upon course, the team itself can fix things by acknowledging where the deviation from the agreed upon plan occurred. This only happens, however, when the course is known and everyone on the team takes responsibility for steering the team on a steady course.
When the group does not demand accountability, the focus on the goal is lost, and team members tend to focus on their personal concerns to the detriment of the team. If the team does not share a vision and goals, the work of the group fails. When team members begin to put their own needs first, trouble is brewing.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

9. Organizational Structure and Culture
When we think of trust, we normally think in terms of reliability:
I trust that if I do a then b will occur.
I trust that if I ask Ray to work on a project, then he'll get it done on time.
I trust that if I assign a work task to Anne, she'll complete it, keeping in mind our company's quality of standards.
We often consider trust to be synonymous with reliability. The following statements illustrate the fuzzy boundaries between trust and reliability:
I trust that if I do a then b will occur.
I trust that if I ask Ray to work on a project, then he'll get it done on time.
I trust that if I assign a work task to Anne, she'll complete it, keeping in mind our company's quality of standards.
Trust among teams is a muddier concept, one rooted in emotional investment. For a team to operate effectively, we must believe that our colleagues have the best intentions, that they will not betray the work of the group or their personal relationships within it.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

10. Organizational Structure and Culture
Is trust easy to build? If so—how?
How do you create good intentions, focus on team more than self, remove personal defenses?
This comes down to commitment from two areas:
Corporate commitment
Personal commitment
How can you create and develop trust? How do you encourage goodwill, build an, "all for one, one for all," mentality, and conquer personal defenses? In short, trust within any kind of organization depends on commitment at two levels: corporate commitment and personal commitment.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

11. Commitments Corporate commitment
If the decision makers, leaders, and owners of a team don't buy into this, then it doesn't matter.
Personal commitment
Trust is a personal commitment ; all are held accountable
Corporate commitment refers to, "buy-in," from the team leaders for the overall goals of the group. Are your leaders looking to advance their own careers and agendas, or do they work for the entire team's success? Simply put, if you can't trust your leaders to invest in the good of the group, then the team will fail. Every team, every day, and at every level, must invest in the group and believe in each member's commitment to its goals.
Corporate commitment provides the foundation for trust, but without personal commitment from individual members, you can't build the structure. Encourage discussions about trust and commitment; some people may experience trust differently, or not realize that their actions convey distrust in others. Open communication about the issue can provide perspective and help members tackle issues as they arise, rather than down the road when faith has been broken.
Many have seen behaviors in teams where management may, “play favorites.” This behavior causes bitterness in the other members of the team. The other members then form their own clique and the team breaks down. Corporate commitment and personal commitment go hand in hand.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

12. Trust
If you don't have trust your team will never achieve its top potential.
Your team will never achieve the type of goals they might be able to if they didn't have to spend so much time defending themselves or worrying that their ideas and thoughts may be rejected.
Trust ultimately starts with each one of the members.
Trust is a hard topic to pin down, especially since it interplays with so many other dysfunctional issues that plague a team. But generally speaking, distrust hinders a group's potential. Members cannot focus on group goals if they worry that their opinions will be dismissed or they suspect others of ill will. Cultivate trust by opening a dialogue among group members, and include leaders. Trust tends to engender trust, so try to connect honestly with your peers, and it's likely that they will do the same.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

13. Signs and Symptoms of Team Dysfunction
Inattention
Tardiness
Lapses in communication
Missed meetings
Missed obligations
Gossiping
Even if your team meetings are, "virtual," a keen eye can spot the signs of dysfunction. Dropped obligations, tardiness, inattention, and irregular communications all point to a lack of commitment by team members. It’s tough enough to lead a dysfunctional team when you can see the members and speak openly eye-to-eye. But when you’re leading a team that’s become disengaged and dispirited, it takes special skills and approaches to re-engage and motivate those who have drifted away.
Let’s talk about dysfunctional team/leadership symptoms and warnings—as the saying goes—a stitch in time saves nine. Detecting the problem in early stages can help prevent it from boiling over.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

14. Symptoms of Dysfunction in Leaders
Dictatorial leadership
No 360 degree feedback
Personal agendas
Political compensation
Inefficient use of resources
Consider the following symptoms of dysfunction:
Dictatorial leadership is a style of management that employs the, "my way, or the highway," approach. These leaders do not entertain disagreements or alternative opinions. No 360-degree feedback means that the organization provides limited or no team performance feedback from subordinates, peers, and/or supervisors.
When personal agendas influence hiring and advancement decisions, resentment occurs and group cohesion is threatened. An example of such a hiring is a manager hiring friends over more qualified employees.
Political compensation, similar to personal agendas, is a way that a dysfunctional leader rewards members for the wrong reasons. This refers to rewards and bonuses that do not reflect performance equitably and so lead to resentment and distrust among employees.
When personal relationships, not business requirements, direct the allocation of monies, the resources are being used inefficiently. This is another indicator of a leader with misaligned notions.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

15. Symptoms of Dysfunction
Empire-building practices
Unequal workload distribution
Top heavy with management
Fragmented organizational efforts
Too much talk
Another symptom of dysfunction is evidenced when managers practice, "empire- building," such as when they link their career success to bigger departments and budgets and influencing others in positions of power to influence their own goals. Power struggles erupt over allocation of funds and control of the team's activities.
Unequal workload distributions is a concept that is pretty easy to understand. Favoritism in assignments and shifts and projects can result in some employees being too busy, while others are not busy enough. The work has not been allocated equitably and it can spawn real resentment and team breakdown.
A company that has too many managers means unnecessary management layers, which can impede communication and efficiency, leading to real team frustration.
Fragmented organizational efforts occur when an organization becomes a collection of individual silos, rather than an interlocking machine. Competition, power struggles, and duplicated efforts result and productivity, efficiency, and communication suffers.
Most of us may be familiar with this one: too much talk. Here, leaders hold unnecessary meetings to plan advancements or innovations that are never implemented.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

16. Symptoms of Dysfunction
Ineffective meetings
Lack of collaboration
Low productivity
Constant crisis mode
Morale deterioration
Backstabbing
Highly stressful workplace
Other symptoms of dysfunction in a team include evidence of ineffective meetings where precious time is wasted with arguing, assigning blame, or belaboring minor issues.
A lack of collaboration is an additional symptom. This lack of collaboration foments competition and hinders a sense of collegiality. Personal benefit becomes a major factor behind decisions.
Low productivity is a symptom that occurs when organizational energies and resources are diverted from work to internal politics. Unattended projects fall behind schedule and fail to meet budget and performance goals.
A team that is in, "constant crisis mode," is not healthy. Teams exhibiting these symptoms are those that are constantly reacting to urgent situations rather than proactively focusing on generating future work.
Declining morale is another red flag for a dysfunctional team. Negative and competitive work environments deteriorate morale, resulting in passivity and disengagement from the team.
Public backstabbing behaviors and gossip among team leaders and across teams is another indicator that a team or possibly an entire organization is failing. Environments like this are far too mired in negative behaviors to move forward.
High stress in the team can be evidenced by missed work days, tardiness, and high rates of turn over or employee resignations.
Many of these symptoms are probably quite obvious and easily identifiable. The point is changing these behaviors is very, very hard work. But it is essential work required of leaders and team members alike to preserve the team and enhance performance.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

17. Goals for Dysfunctional Teams
Truly cohesive teams are obvious.
They trust one another.
They engage in unfiltered conflict around ideas.
They commit to decisions and plans of actions.
They hold one another accountable for delivering against those plans.
They focus on the achievement of collective results.
What does a functional team look like?
Truly cohesive teams are obvious. They trust one another and the commitment is obvious. They engage in honest and frank discussions around ideas – even if it involves conflicting ideas. Cohesive and high-performing teams commit to decisions and plans of actions, and they hold one another accountable for delivering against those plans. A functional and high-performing team is focused upon the achievement of collective results.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

18. Strategies to Manage Dysfunctional Teams
Outlining the current state
State your observations with specific examples and express your concerns.
Listen intently.
Create a safe discussion space.
Crystallize the underlying problems.
We present a few strategies for managing dysfunctional teams, beginning with defining the current state.
It is important that assertive communication techniques are planned and employed to deliver your message and change employees' behavior. For example, if poor participation at weekly meetings is an issue, you could direct an to your team members, with a subject line requesting attendance at the next meeting. Begin the by noting your observations, supported by specific examples and descriptions of how the lack of participation hinders the work of the team. Then, ask your team members to prepare to discuss the issue at the next meeting. Follow the with a personal phone call.
During the meeting, describe your concerns in greater detail, using "I" statements. Do not pressure others to speak, but encourage them to share the reasons behind their behaviors--perhaps by admitting your own waning enthusiasm for the weekly meetings. Your shared experience will help create a safe space for members to offer their perspectives. Ask open-ended questions to encourage thoughtful feedback. Listen intently. Pay careful attention to the conversation, asking for clarification when necessary. If discussion stalls, offer the opportunity to respond anonymously, perhaps through a dedicated chat room. Do not judge or accuse.
Once you have identified the underlying problems, crystallize them by stating them in clear, unambiguous language, and prioritize them according to their detrimental effect on performance. Request your employees' help in resolving the issues.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

19. Strategies to Manage Dysfunctional Teams
Moving toward future state
Collaborate on the best solutions.
Seek commitments to be part of the change.
Take the team’s temperature often.
Reach out to disaffected individuals personally.
Once the current state is defined – it is time to move to the future or desired state. Collaboration on the solutions is vital; it reengages the team as a team.
Tackle relatively easy problems first, such as scheduling a more convenient meeting time. Then move on to tougher issues, such as redistributing the workload so that everyone has time to attend the meetings. Take notes of action items and those responsible, and continue to update the team on your efforts to arrive at a solution. Document the related actions and responsible people, and keep the team updated as to your collective progress. Seek commitments from all to be part of the change.
 Ask each of your team members to address the entire team as they share their plans for changing behaviors. For instance, the person who is habitually late will commit to scheduling a reminder in her online calendar.
Continue to monitor (or take the teams temperature), in a non-confrontational way, the team's commitment to the change. If they fall back into old habits, it may be difficult to rein them back in. If you haven't already, establish a relationship with each of your team members. Take note of backsliders, and open a one-on-one personal dialogue with them--there may be external reasons for certain behaviors. Despite their best efforts, some people simply take time to adjust to change. Deliver positive feedback, emphasizing that everyone's contribution to the meeting is valued.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

20. Strategies to Manage Dysfunctional Teams
Model the behavior of best practices
Treat team meetings as the most important event on your calendar.
Let people know what’s expected of them in advance.
Come prepared with an agenda and stick to it. Check in to see how people are doing.
Project enthusiasm and energy.
Applaud team and individual achievements both large and small. Check in with the team as soon as possible.
Much of the realigning of dysfunctional teams will come from within you. Consciously model best practices behavior. Prioritize the team in your schedule. Distribute an agenda and encourage others to add to it. This way people know your expectations in advance. Limit the distractions or deviation from the agenda. Convey energy and enthusiasm, and others will feed off of it. Acknowledge team members' successes of all kinds.
These kinds of strategies will help you manage dysfunctional behavior before it gets too ingrained, and your commitment will encourage others.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

21. Group Think—Another Strategy
A, “Road to Abilene,” paradox describes what happens when group collectively decides to do something that no individual in the group really wants to do.
The term comes from the Abilene Paradox, demonstrated by the story of a family who decides to travel 53 miles north to Abilene for dinner.
On the way back, they begin arguing after realizing that none of them wanted to go in the first place, but no one spoke up.
A, "Road to Abilene," paradox occurs when a group collectively decides to do something that no individual in the group really wants to do, but everyone thinks that the other wants to do it, so they remain silent. This is also referred to as, “not rocking the boat,” or, “group think.”
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

22. Lessons Learned from the Road to Abilene
Avoid false consensus.
Overcome the fear of speaking out.
Encourage effective decision-making within a group.
Consider these lessons learned from the paradox of the Road to Abilene:
Avoid false consensus. Don’t assume that everyone else is thinking the same thing as you. Speak your mind—don’t be afraid to speak out. You do not have to be confrontational. Encourage open communication and effective decision making within a group. It is OK to question and debate the direction.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

23. Results/Rewards Expected from Maneuvering a Dysfunctional Team
A sustained competitive advantage gained through greater collaboration, improved communication, and a sense of team unity.
Improved organizational performance as team members are able to work together toward common goals.
Increased employee morale.
Reduced employee turnover.
A reduction in unproductive interpersonal conflict
Increased productivity.
There are rewards for dealing with a dysfunctional team and righting the course. A sustained competitive advantage can be gained through greater collaboration, improved communication, and a sense of team unity. This can result in improved organizational performance as team members are able to work together toward common goals. Employee morale is improved, which results in reduced employee turnover. When distractive interpersonal conflict is reduced, productivity is increased. The long and short of it is that if the team is capable of more, and are just falling into the mire of dysfunctional behavior – it can be reversed. This is not to say that all teams can and should be saved. It is up to the wise leader and high performing team to self-prune. It may be necessary to realign and reconstitute teams.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

24. Barriers to Success: Reading Early Warning Signs of HIT Team Failure Summary
Embracing common sense and uncommon levels of discipline and persistence make successful teamwork.
By acknowledging the issues and problems of the team members, members of functional teams overcome the natural tendencies that make teamwork so challenging and non-transparent.
This concludes Working in Teams: Barriers to Success: Reading Early Warning Signs of HIT Team Failure. In summary, you learned to:
Recognize key signals of team failure.
Use appropriate response mechanisms to address team dysfunction.
Facilitate consistent scanning for symptoms of potential team failure.
To close, it is important to note that good players rarely leave successful teams that value their contributions. Effective teamwork requires discipline and effort, good communication, and a very human commitment to shared goals. Being able to detect the warning signs of a failing team is a powerful tool in helping them to reverse course before the team slides into total dysfunction.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure

25. Barriers to Success: Reading Early Warning Signs of HIT Team Failure References
Jones. M. Dysfunctional Leadership & Dysfunctional Organization. International Institute of Management. Available from:
The Five Dysfunction of a Team Workshop and Training Program. c2005. Available from:
Lencioni, P. Conquer Team Dysfunction. The Table Group. c2007. Available from:
Settle-Murphy, N. Recognize and address early signs of virtual team dysfunction to avoid irrecoverable problems later. c2006. Available from:
No audio.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Working in Teams Barriers to Success Reading Early Warning Signs of HIT Team Failure