Look for these stages along road to teamwork

If you’re thinking about moving to a team approach in some departments of your facility be prepared for — and warn staff about — normal bumps in the road, advises Christine O’Shea-Roper, who was formerly team development program manager at the M.D. Anderson Cancer Center in Houston.

In the spring of 1996, O’Shea-Roper began the task of helping convert the entire hospital and clinic operation to a team concept.

Team concept flexible

The team concept gives the department greater flexibility to meet the customer needs of both 24-hour inpatient operations and daily outpatient clinics.

The hospital information management department is a little more than a year into a process that could take two years to finish. Generally, the initial training and skill building needed for a team conversion can be accomplished relatively quickly. But to become high performing, self-directed teams can, in some cases, take as long as five years to complete, she adds.

Before embarking on the training, O’Shea-Roper advises you to prepare staff for the natural ups and downs. "We employ the four stages of team growth referred to in the literature as forming, storming, norming, and performing."

At first, employees "are pumped up and enthusiastic; then reality sets in, and the teams begin to realize that they are not going to function perfectly from the beginning, that they need practice. There are unanswered questions and frustration. The storming process also raises the issues that test the conflict resolution process on your teams. It is a good opportunity to ensure team member understand how to deal with conflicts and resolve them. By the norming stage things are beginning to work out with consistency, and the team is beginning to reach some goals. Finally, during performing, they achieve objectives, set their own goals, and constantly work to improve themselves, she says.

In my experience, most teams do not reach performing stage until six to nine months after the initial training."

Throughout the process, keep in mind these four expectations of team members, she adds:

communication;

cooperation;

contribution;

commitment.

At the end of the team training each team member is asked to sign a contract. It may not carry the force of law, but it does amount to a pledge of commitment to the team, she says. (For a sample copy of the contract, see p. 120.)

An issue critical to the success of restructuring to a team concept is to show staff the benefits of the changes. "There have to be some very specific benefits to team members, things they can relate to," she says. "I’d suggest you not go into teams until you’ve added that into the plan because commitment to the team is the most important element.

"Among the key benefits team members should be aware of is that they are able to cross-train in order to share workload, share information to more quickly provide service, and solve problems as a team in order to stimulate innovative ideas," she says.

American College of Emergency Physicians, P.O. Box 619911, Dallas, TX 75261-9911. Telephone: (800) 798-1822, Ext. 3235.

Darlene Bradley, RN, MSN, MAOM, Director for Emergency and Express Care Services, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA 92354. Telephone: (909) 478-8077.

Brent Fisher, MBA, FACMPE, Administrative Director for the Emergency Physician Group, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA 92354. Telephone: (909) 824-0800, Ext. 81505.

Nancy Hughes, Vice President of Information and Research Services, American Academy of Physician Assistants, 950 N. Washington St., Alexandria, VA 22315-1552. Telephone: (703) 836-2272.

Thomas Kelly, Associate Hospital Director for Financial Services, Medical College of Georgia , 1120 15th St., Augusta, GA 30912. Telephone: (706) 721-3926.

Robert McVicker, CPA, FHFMA Senior Assistant Hospital Director/Finance for the Medical College of Georgia, 1120 15th St., Augusta, GA 30912. Telephone: (706) 721-8689.

Larry Mellick, MD, FAAP, FACEP, Chairman and Professor of the Department of Emergency Medicine, Medical College of Georgia , Room BP-1022, Augusta, GA 30912. Telephone: (706) 721-7144.

Lee Smith, MD, JD, Assistant Professor in the Department of Emergency Medicine, West Virginia University, P.O. Box 9149, Health Sciences Center, Morgantown, WV 26506. Telephone: (304) 293-2436.

Lydia Washington, RRA, Director of Health Information Management, University of Texas, M.D. Anderson Cancer Center, Houston. Telephone: (713) 792-2121. World Wide Web: http://utmdacc. uth.tmc.edu/