1. Examples and Characteristics
Working in Teams
Health IT Teams:
Examples and Characteristics
Welcome to Working in Teams: Health IT Teams: Examples and Characteristics. This is Lecture b.
Lecture b
This material (Comp 17 Unit 1) 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 This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.
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Health IT Workforce Curriculum Version 4.0

2. Health IT Teams: Examples and Characteristics Learning Objectives—Lecture b
Describe the characteristics of an effective team and work group.
Identify and differentiate roles of IT health care professionals in teams.
Describe the value of teams and the importance of collaboration for the IT professional in teams.
The Objectives for Health IT Teams: Examples and Characteristics are to:
Describe the characteristics of an effective team and work group.
Identify and differentiate roles of IT health care professionals in teams.
Describe the value of teams and the importance of collaboration for the IT professional in teams.
The first part of the lecture focused on effective teamwork and how teamwork is divided into three main dimensions: organizational structure, individual contributions, and team processes. We will continue this discussion and will then look at the components of effective teams, the values of teams, and the importance of collaboration. You will be identifying and differentiating roles of IT health care professionals in teams, and you’ll be doing that by doing some personal activities, research, and interviewing, as well as looking at some actual scenarios of health care professionals at work in teams. And finally, when you complete this unit, you will be able to describe the value of teams and the importance of collaboration for the IT professional in teams. We will accomplish that by investigating some of the resources available in this unit.

3. Clear Purpose/Mission
Goal agreement through a common commitment to patients’ needs.
Action that will improve the quality of care.
Health care teams need to identify appropriate patient-related goals and link these with both team and professional goals, while upholding the organization’s mission.
(Maple, 1987)
In referring to the grid in Lecture a that illustrated the characteristics of an effective team, we saw that a clear purpose is first and foremost. As with any team effort, a clear purpose or goal needs to be established. While goals can be (and often are) set by management, an effective team must be aligned and vested in achieving the goal, or outcomes can be suboptimal. Agreement around a goal in health care is often achieved through a common commitment to patients’ needs or actions that will improve the quality of care. According to an article by Gwyneth Maple in an occupational therapy journal, health care teams need to identify appropriate patient-related goals and link these with both team and professional goals, while upholding the organization’s mission.

4. Appropriate Culture
Define expectations and mechanisms of accountability for all teams.
Shared team vision and experiences of success
Other hallmarks of the characteristics of an organization that contribute to high quality teams are those that provide clearly defined expectations and team members quickly understand why they have been included in a given team. Accountability is an important feature; teams must understand what is expected and what the impact is on the whole project if the team fails to collaborate and deliver. Good teams have a diversity of backgrounds and opinions that help them work through complex issues as they deal with their mission and tasks. They have a shared vision and are ready, able, and willing to share experiences of success. An appropriate culture is one that is able to accept diversity, encourage the voicing of opinions, even if they are ones that the organization does not want to hear, and one that enables the team to move in ways that out-performs single individuals.

5. Specified Task Motivating for the team members
Shared responsibility and accountability for the achievement
Health care IT teams need to clearly define the specific aspect of complex and inter-related patient care that they address.
Another element of organizational structure is the specified task. It is important that teams know what the specified task responsibilities are for that team, the tasks must be motivating for the team members and the task must be clearly defined. There will be individual tasks that will be part of the team’s work, but overall the team has a shared responsibility and accountability for the task. In health IT teams, a high performing team will be focused on the specific aspect of the task at hand, and while they need to comprehend and appreciate the complexities and interdependencies that are inherent in working in health IT – they must stay focused and not get lost in the maze. For example, something that seems quite simple and straight forward soon can become overwhelming – if the scope is allowed to creep and the focus is lost.

6. Distinct Roles
Roles can be flexible enough in a team to accommodate individual differences, personal development needs, and changes in the members of the team.
Conflicts can be alleviated when the professionals work across disciplinary boundaries in the best interest of the members of the team.
In discussing the distinct roles that a team possesses, and as we said earlier, teams that are diverse typically outperform teams that are homogenous. The value of the diversity plays out in both decision-making roles, as well as in creating other forms of deliverables that the team will get involved with. When roles are flexible enough to accommodate individual differences and needs, then teams are strengthened. Conflict management is a very important element of teaming—and it’s important to acknowledge that we are talking about conflict management, not conflict resolution in this regard. Why? Because you want conflicts to be dealt with, and the alleviation of conflict is in its management, not in its exclusion. So, to manage conflict within teams we must clarify and understand the value of separate and distinct team members functioning within separate and distinct roles.

7. Leadership Leadership should reflect the team’s stage of development.
Strategic focus must be maintained
Teams that have a wide variety of responsibilities and a complex task need strong leadership. Team leadership may come from more than a single source, therefore leadership can be shared and not fall upon a single individual. If we have diversity in the team, the leadership should also be diverse. In fact there are many who believe that teams should be “leaderful” meaning that the individual on a team who is closest to the information at any given point in time, or whose expertise is closest to what needs to be done, should be in a leading role during that specific activity of the team. Regardless, strategic leadership must be maintained as the team moves toward goal attainment.
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8. Relevant Members Right amount of members
Appropriate mix and diversity of task and interpersonal skills
In addition to suitable leadership, teams need to make sure that they not only have the right expertise on the team, but that they have the relevant and right number of members on the team. Size is a critical issue for any team. Health IT teams, depending on scope, can be hindered by the aspects of both size and team member relevancy. Health IT projects particularly in acute care facilities can be very complex, requiring numerous teams with large membership. As size increases so does complexity of interactions, pointing to the critical importance of the team being comprised of appropriate members with robust interpersonal skills. For example, a local hospital health IT group had a very large team set up for an implementation project to replace the system that was being used in the surgical units. Very quickly it became obvious that the team was too large and unwieldy. A decision was made to break the large group down into smaller, more agile and more focused teams. By creating smaller teams, faster and more detailed progress was made, and the linkages that existed before the small group breakouts facilitated a coalescence back into the larger group when necessary.

9. Adequate Resources
Financial assistance, administrative and technical support, and education and training
Safe physical environment
In health care environments, a potential for conflict can exist due to clinical responsibilities, training needs, and issues of patient safety and confidentiality.
(Hackman, 1990)
The final element in organizational structure area is that a team needs to be provided with adequate resources. These resources can come in a variety of forms, from financial support to equipment, to training and technical assistance. Other dimensions of adequate resources is in the provision of a safe physical environment – an aspect that is faced all too often by health care providers in conflict zones, or visiting nurses who are traveling into dangerous urban areas. Adequate resources are difficult to guarantee, especially in a depressed economy, therefore conflict over this dimension can arise, Hackman, in writing about effective teamwork, points out that conflict in a team can also arise in health care environments when things such as clinical responsibilities, patient safety, training needs, and the like interfere with each other.

10. Individual Contributions
Think about the teams you have been on. What do you see as your contributions?
Effective teams contain individuals with:
self-knowledge
trust
commitment
flexibility
Now we move into the second area of characteristics of effective teamwork from that framework we presented in lecture a: individual contributions. Before we take a deep dive into this aspect, think about a team that you have been on in the past. While you participated as a team member, were there things that you, as an individual, contributed to the overall outcome? It is important to acknowledge that a team is made up of individuals who have self-knowledge, people who can help to grow trust across the team, people who are committed and flexible.

11. Self-Knowledge Personal and professional
Understanding of the colleagues’ skills and responsibilities
Professional expectations
Perceptions of colleagues’ images of the individual
What is meant by the term self-knowledge and how does it relate to a team? A strong team member is one who possesses a good deal of self-knowledge – they understand the process or the organization, they have confidence in their own abilities. Those with self-knowledge have professional expectations of team outcomes, and have both personal and professional wisdom. Finally those with self-knowledge have an understanding of how knowledge gained from their previous experiences can contribute to the success of the team.

12. Trust
Through developing confidence in each other’s competence and reliability
Need to discuss openly any similarities and differences in their professional values and standards
The second element under individual contribution is trust. The individual characteristic of trust is exhibited by a belief that your teammates are all clearly headed in the same direction, and they’re reaching for the same goals that you are. A lack of trust among teammates is particularly destructive it often causes more than a disruption of the team process; it can cause a complete failure in terms of the team’s ability to deliver. All members of the team regardless of social standing or professional background should be recognized for their expertise, and that level of trust and confidence needs to be maintained across the board.
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13. Commitment Developed via self-knowledge and ability to trust
Willingness for short-term personal sacrifice for good of the team
Commitment is seen as an individual team member’s ability to give up some of his or her short-term goals for the good of the team and it is developed by confidence in one’s own abilities and beliefs. In health care IT teams, a commitment to the team, the project and the outcome may result in personal sacrifices such as living at the facility for an entire weekend as the new system is brought up, or being the one to volunteer to travel to the remote clinic to trouble-shoot a problematic aspect of a newly installed ambulatory system.

14. Flexibility Open attitude Accommodate different personal values
Be receptive to the ideas of others
The final element in our list of contribution characteristics is flexibility. Flexibility is the ability to have an open mind, to tolerate ambiguity, to cherish the diversity of opinion, and to basically be open and accommodating to the opinions of other people. It requires honest, reflective, and sometimes a regulation sense as a team works toward reaching its goals. Flexibility is critical in any team, but even more so in healthcare and health IT. Seldom does any project go according to plan. Even the best laid plans require a change, and due to the rapidly changing face of health IT, flexibility is a required trait for health IT professionals.

15. Team Processes Coordination Communication Cohesion Decision-Making
Conflict Management
Social Relationships
Performance Feedback
The third aspect of organizational characteristics that impact successful teams are the processes used by teams to achieve the goal. Team processes describe aspects of interaction and team behaviors. Team processes will be described in terms of seven characteristics:
Coordination
Communication
Cohesion
Decision-Making
Conflict Management
Social Relationships
Performance Feedback

16. Coordination & Communication
Embrace member variety
Incorporate different perspectives of members
Optimize integration of unique skill sets
Communication
An observable exchange of information - interactions of power, attitudes, and values
Team coordination is a very important process and relates closely to team diversity and appreciation that we discussed earlier. A coordinated team is one that embraces diversity while finding an effective and efficient way to incorporate diversity of thinking. Optimizing integration of unique skill sets is another process used by successful teams. Communication processes used by successful teams result in an observable exchange of information, visible interactions of power, and an open and trusting discussion of attitudes and values.

17. Cohesion
This attribute acknowledges members’ personal attraction to the team and the task. Members cooperate interdependently around the team’s task to meet team goals.
Another important characteristic under team processes is cohesion. It is important that teams be able to work together in a fashion that leads to an articulation of purpose as they move through the various dimensions of their task performance. Cohesion is necessary for teams to cooperate interdependently around a team task. As cohesive teams work, individual team members see their value —their individual contributions—as being part of that cohesive whole of the team. Cohesive teams are right-sized – because we know that a team cannot be so large that cohesion is impossible. In addition, the team cannot be so dispersed that meaningful interaction is difficult.

18. Decision-Making
A range of team members’ knowledge and skills that contributes to expand information and generates more legitimate decisions
The process of decision-making that a team uses is another characteristic. Decision-making is certainly an individual activity, yet highly successful teams actually share in decision-making processes.
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19. Conflict Management Aid in creative thinking
Address elements of destructive team processes
Another element of team characteristics under team processes is that of conflict management. We’ve already highlighted the value of teams in terms of providing optimal solutions, and they do that partially by being able to generate creative thoughts. Creative thinking is heightened by diverse opinions, but those same diverse opinions can sometimes cause destructive team processes. The ability to manage conflict is therefore very pertinent as we move toward addressing those kinds of elements that could lead to destruction, or could lead to breakthroughs in our thinking. So sometimes it’s a fine line, and that’s why conflict management is so important when we’re talking about team processes as a characteristic of effective teamwork.

20. Social Relationships Showing empathy and support
Offering assistance when needed
Sharing information
Mutual problem solving
Another element of team characteristics under team processes is that of social relationships. This is an important area for obvious reasons. Teams are made up of people. The ability to offer assistance when others are requesting it, to share information, not hoard information, and to be involved in a mutual problem-solving environment are vital characteristics as relationships are built within teams.
In health care IT the teams are diverse, yet overlapping. Much of the teamwork is centered on an activity that is geared to make someone’s life easier—be it new personal health record for a patient population, or making a billing clerks life easier by automating tedious and error-prone portions of his job. The social relationships that emerge when health IT teams are assembled can be very enriching for team members.

21. Performance Feedback Timely and accurate Should focus on the future
Open communication channels
Targets team performance
Performance feedback, our final characteristic under team processes, is an important element. High performing teams are absolutely reliant on this aspect. Dimensions of performance feedback that contribute to team functioning include the targeting of team performance with a focus towards the future and using open communication channels. We cannot expect improvement and change to occur unless the team is informed of progress. This point cannot be stressed enough in Health IT. The health care environment is changing rapidly, therefore teams that are planning, implementing, or procuring health IT rely on feedback. It helps them to benchmark and measure the impact that the new system (or the new process or the new technology) has on a particular outcome. Feedback is essential.
All of these characteristics are used within the context of health in general and health IT specifically. However, a team – regardless of purpose or location – shares many of these same traits and activities. Ultimately, team work is vital to healthcare and understanding these characteristics and their relationship to building, planning, or implementing health IT is critical for the health IT professional.

22. Health IT Teams: Examples and Characteristics Summary—Lecture b
Characteristics of Effective Teamwork
Organizational Structure
Individual Contribution
Team Processes
Roles of Health IT Teams
Value of Collaboration for Health IT Professionals
This concludes Lecture b of Health IT Teams: Examples and Characteristics. We believe that this lecture has given you an appreciation for the characteristics of effective teamwork, as they relate to organizational structure, individual contribution, and team processes. We hope that you have a handle on the roles of health IT teams in the health care industry, and that you have an appreciation for the value of collaboration, and how that can impact health IT professionals.

23. Health IT Teams: Examples and Characteristics References—Lecture b—1
Hackman JR, ed. (1990) Groups that work (and those that don't): creating conditions for effective teamwork. San Francisco: Jossey-Bass;
Katzenbach JR, Smith DK. (1993) The Wisdom of Teams: Creating the High-Performance Organization, Harper Business, New York
Maple. G. Early Intervention: Some issues in co-operative team work Australian Occupational Therapy Journal,1987.
Mickan S, Rodger S. Characteristics of effective teams: a literature review. Australian Health Review. 23(3):
Norm N. The Value of Teams in the Workplace. The University Record Oct 8; Available from:
Richard AG, Dickson MW. (1996) Teams in Organizations: Recent Research on Performance and Effectiveness. Annual Review of Psychology. 47(1):
Zeff LE, Higby MA. (2002) Teaching More Than You Know. Academic Exchange Quarterly. 6(3).
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24. Health IT Teams: Examples and Characteristics References—Lecture b—2
Images
Slide 7: Stairs in the Forest. Photo by Tim Green aka atouch via Flickr, used under the Creative Commons License.Available from:
Slide 12: The word trust written on a stone wall. Photo Credit: Flickr user vagawi (Creative Commons). Available from:
Slide 16: Communication. "Communication" by DailyPic (Joan M. Mas), under a Creative Commons license on flickr. Mas is a graphic designer and illustrator at vectoralia.com.Available from:
Slide 17: Cohesion. The picture, by FredArmitage/flickr is reproduced here under a Creative Commons Attribution-Non-Commercial-No Derivative Works 2.0 Generic license. Available from:
Slide 18: Decision Making. Image by: SeanbJack via Creative Commons License. Available from:
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25. Working in Teams Health IT Teams: Examples and Characteristics Lecture b
This material (Comp 17 Unit 1) 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 This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.
No audio.
Health IT Workforce Curriculum Version 4.0