Teams, TeamSTEPPS, and Team Structures: Models for Functional Collaboration

Contents

Slide 1. Teams, TeamSTEPPS, and Team Structures: Models for Functional Collaboration
Slide 2. Rules of Engagement
Slide 3. Upcoming TeamSTEPPS Events
Slide 4. Help Line (312) 422-2609
Slide 5. Today's Presenter
Slide 6. No conflicts of interest
Slide 7. Objectives
Slide 8. Groups and Teams
Slide 9. No Slide Title
Slide 10. TeamSTEPPS Definition
Slide 11. No Slide Title
Slide 12. Team Structures
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Slide 15. No Slide Title
Slide 16. Hierarchy
Slide 17. Strengths of Hierarchies
Slide 18. Liabilities of Hierarchies
Slide 19. Where hierarchies are successful
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Slide 23. Heterarchy
Slide 24. Decisions and Communication
Slide 25. Strengths of Heterarchies
Slide 26. Liabilities of Heterarchies
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Slide 28. No Slide Title
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Slide 30. Holacracy
Slide 31. Decisions and Communication
Slide 32. Strengths of Holacracies
Slide 33. Liabilities of Holacracies
Slide 34. No Slide Title
Slide 35. Possibilities to consider
Slide 36. Learning to be on a team
Slide 37. Paradigm Shift to Team Approach
Slide 38. Teams and Communication
Slide 39. Ultimately
Slide 40. References
Slide 41. Contact Information
Slide 42. Questions and Answers


Slide 1

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Teams, TeamSTEPPS, and Team Structures: Models for Functional Collaboration

February 8, 2017

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Slide 2

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Rules of Engagement

  • Audio for the webinar can be accessed in two ways:
    1. Through the phone (*Please mute your computer speakers).
    2. Through your computer.
  • A Q&A session will be held at the end of the presentation.
  • Written questions are encouraged throughout the presentation and will be answered during the Q&A session
    • To submit a question, type it into the Chat Area and send it at any time during the presentation.

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Upcoming TeamSTEPPS Events

  • Master Training Courses
    • Registration for courses through June 2017 now open.
    • Registration opening on January 18 for courses in April-June 2017.
  • National Conference
    • June 14-16, 2017
    • Downtown Hilton, Cleveland, OH.
    • Registration open and filling up fast!

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Help Line (312) 422-2609

Or email: AHRQTeamSTEPPS@aha.org

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Today's Presenter

  • William (Bill) Gordon, DMin, MDiv
  • Faculty, Department of Interprofessional Healthcare Studies
  • Rosalind Franklin University of Medicine and Science
    North Chicago, IL

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No conflicts of interest

I have no conflicts of interest to declare in relationship to this presentation

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Objectives

  • Learn to analyze team structures by reviewing an organizational diagram, hypothesizing the assets and challenges to relationships, communication, and accountability.
  • Differentiate between hierarchy, heterarchy, and holacracy as models of team organizational strategies
    • Evaluate these structures utilizing the TeamSTEPPS domains of leadership, situation monitoring, mutual support, and communication.
  • Consider possibilities of hybridized organizational models for task or time specific teams.

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Groups and Teams

In a group, focus is on individual results

  • People are free to act independently, regardless of the behavior of others

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In a team, success belongs to the whole, not to individuals

  • People are interdependently related, rather than being independent.

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TeamSTEPPS Definition

Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership.

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Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership.

  • This definition is largely behavioral, describing how members interact.
  • It does not, by definition, require a team to be interprofessional or even multidisciplinary.

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Team Structures

How teams are structured or organized may affect:

  • How team members understand relationships to one another.
  • How communication flows.
  • Levels of personal accountability (based on decision-making strategies).

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The Hierarchy diagram: This is a bubble diagram with one ball at the top with arrows pointing to 5 balls beneath it.

* Variations are possible, largely based on leadership styles and skills.

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A more complex hierachy bubble diagram where the top of one bubble is connected to one of the bottom bubbles of another. It goes down about 5 levels. There is a "you are here" sign and an arrow pointing at one of the very bottom bubbles.

  1. Relationships.
  2. Communication.
  3. Personal Accountability.

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A more complex heirarchy bubble diagram where the top of one bubble is connected to one of the bottom bubbles of another group. It goes down about 5 levels. There is a "you are here" sign and an arrow pointing at one of the very bottom bubbles. There is a "the vision is here (heroic model)" and an arrow pointing to the very top bubble.

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Hierarchy

  • Characterized by "single node ascendancy" (Hero)
    • One person or group is in charge.
  • In compliance driven hierarchies, power distribution is seen as "power-over" rather than "power-shared".
  • Election to leadership is often based factors such as longevity/seniority.

The Hierarchy diagram: This is a bubble diagram with one ball at the top with arrows pointing to 5 balls beneath it.

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Strengths of Hierarchies

Efficiency and Familiarity

  • Very efficient model for the transfer of information to a group of limited size (i.e. small)
    • Hierarchies can structure information flow.
  • Many organizational structures in our culture are built on hierarchies.

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Liabilities of Hierarchies

The Hierarchy diagram: This is a bubble diagram with one ball at the top with arrows pointing to 5 balls beneath it.

Communication

  • Can be compromised by lack of trust and lack of access to decision-makers.

Disengagement

  • Lack of power at the edges may impact "buy-in".

Poor accountability

  • As long as compliance-driven orders are received, workers can defer to having followed those instructions, and are not considered culpable.

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Where hierarchies are successful

  • Public safety.
  • Military.
  • Emergent situations where information flow is uni-directional.
  • Teaching/education.

Hierarchies in and of themselves are not bad.

Non-reflective use or abuse of power within hierarchies amplifies their liabilities.

The Hierarchy diagram: This is a bubble diagram with one ball at the top with arrows pointing to 5 balls beneath it.

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  • Leadership: Potentially less- or non-collaborative, may not foster a relational model
  • Situation Monitoring: May be difficult to see the "big picture" as relationships are defined by position
  • Mutual Support: Depending on leadership, lateral access/communication may be difficult
  • Communication: Can be compromised by poor lateral communication and by filtering effects of passing information through layers of organization

The TeamSTEPPS triangle with an arrow pointing from each box inside to its corresponding definition in the text.

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  1. Relationships.
  2. Communication.
  3. Personal Accountability.

The Heterarchy diagram where the bubbles are more weblike and decentralized.

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The Heterarchy diagram where the bubbles are more weblike and decentralized.

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Heterarchy

  • Characterized by shared organizational structure that is web-like or hive-like
  • Generally considered to be a decentralized or shared power structure
    • Power transfers are fluid (happen easily and quickly)
  • Leadership may be based on information rather than education, position, longevity, title, etc.

The Heterarchy diagram where the bubbles are more weblike and decentralized.

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Decisions and Communication

Information flows non-symmetrically across the network

  • There is no formal "chain of command"

Because of the shared power structure, edges are less likely to be constrained

  • Relationships tend to be non-linear

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Strengths of Heterarchies

Fluidity

  • The structure adaptable to challenges and changes

Transparency

  • Because communication is transparent, trust is generated

Accountability

  • Movement away from individual successes, elevation toward team accountability

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Liabilities of Heterarchies

Uncertainty

  • Unfamiliarity with structure leads to concern that "nobody is in charge"

Informal channels of communication

  • Not all information permeates the entire structure
    • Information flow tends to follow a pattern of needs

Maintenance

  • Requires reflective process among team members

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  • Leadership: Tends to be more fluid, based on information rather than titles, seniority, etc.
  • Situation Monitoring: Transparency is possible through open communication and access.
  • Mutual Support: Vision is held by the whole, reinforcing need for enabling success of each team member. We all succeed or no one does.
  • Communication: Open, undefined by title, based on need, can be targeted to specific areas.

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  1. Relationships
  2. Communication
  3. Personal Accountability

Holacracy diagram: Where central points are connected and each central point has a variety of other points around it.

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Holacracy diagram with a circle around it

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Holacracy

Requires team members be fully calibrated to the stated vision

  • Team members assume roles based on team need

Assignments are fluid based on need in alignment with vision

  • Team member contributions may vary greatly across function and task

(Self-organizing, autopoietic)

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Decisions and Communication

More autonomy is given to individuals to make decisions

  • Can lead to high innovation
  • Requires a strong sense of team values

Communication must be central to team functioning

  • Requires reflective ability and calls to accountability

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Strengths of Holacracies

  • Fluidity
    • Adaptive structure.
  • Valuing of Individuals
    • High importance placed on every member of the team.
    • On-going opportunities for collaboration.
  • Connection
    • Increasing connection (and adaptation) of.
    • structure to team vision.

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Liabilities of Holacracies

Emergence

  • No hard rules, emerging organizational structure
    • May be more difficult to implement where established roles and responsibilities are more rigid/clearly defined.

Non-participation

  • Potential for passengers. Requires trust and development of organizational culture.

Tracking

  • Completion of tasks in a timely fashion may be harder to track.

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  • Leadership: A lot of member autonomy and empowerment changes leadership model to "facilitator".
  • Situation Monitoring: Transparency allows view of larger organization (and possibly more experience across differentiated tasks).
  • Mutual Support: Early reports are this model engenders positive relations (i.e. "my community" rather than "my job").
  • Communication: Can be challenging to be certain all who need to know are informed; may be more difficult to track tasks.

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Possibilities to consider

Hybridizing

Consider for task or time specific teams.

A combination of the Hierarchy diagram and heterarchy diagram where the heterarchy diagram is connected to the bottom bubbles of the Hierarchy diagram.

Perhaps the biggest challenge will be to reframe leadership.

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Learning to be on a team

Being on a team requires a different focus by individual members.

  • Focus is on team outcomes, not individual successes or "wins".
  • The team succeeds or fails together (as a team).

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Paradigm Shift to Team Approach

From (INDIVIDUAL)

Single focus (practice skills).
Individual performance.
Under-informed decision-making.
Loose concept of teamwork.
Unbalanced workload.
Having information.
Self-advocacy.
Self-improvement.
Individual efficiency.

To (TEAM)

Dual focus (practice and team skills).
Team performance.
Informed decision-making.
Clear understanding of teamwork.
Managed workload.
Sharing information.
Mutual support.
Team improvement.
Team efficiency.

Practice skills refers to those skills you must have to do your job. The term applies to sets of clinical and/or non-clinical skills.

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Teams and Communication

One of the greatest challenges about learning to collaborate with others is to find a system for communicating effectively.

One-on-one conversations are different from team communications.

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Ultimately

  • Not all leaders or leaderships styles are successful with all types of organizational structure (i.e. compliance driven leadership may not be suited for collaborative teams)
  • How we organize our teams may impact, or perhaps even dictate how those teams can function, and what their outcomes will be

We have choices.

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References

  • Graphics are generated by Bill Gordon and may be used freely without attribution.
  • Images (with the exception of the presenter's photograph) are from the Public Domain collection of the New York Public Library
  • Mattessich, P. W., & Monsey, B. R. (2001). Collaboration--what makes it work: a review of research literature on factors influencing successful collaboration. St. Paul, MN: Fieldstone Alliance.
  • Robertson, B. J. (2015). Holacracy: the revolutionary management system that abolishes hierarchy. London: Portfolio Penguin.
  • Weiss, D., Tilin, F. J., & Morgan, M. J. (2014). The interprofessional health care team: leadership and development. Burlington, MA: Jones & Bartlett Learning.
  • Wheatley, M. (2006). Leadership and the new science: discovering order in a chaotic world, 3rd ed. San Francisco, Calif: Berrett-Koehler.

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Contact Information

Dr. Bill Gordon

William.Gordon@rosalindfranklin.edu

847-578-8327

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Questions and Answers

For more information, please contact our team at: AHRQTeamSTEPPS@aha.org

Page last reviewed February 2017
Page originally created February 2017
Internet Citation: Teams, TeamSTEPPS, and Team Structures: Models for Functional Collaboration. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/events/webinars/feb-2017.html