Look for these stages along road to teamwork
Look for these stages along road to teamwork
Expect forming, storming, norming, performing’
If you’re thinking about moving to a team approach in your medical records department be prepared for and warn your staff about normal bumps in the road, advises Christine O’Shea-Roper, team development program manager at the M.D. Anderson Cancer Center in Houston.
About a year ago, O’Shea-Roper began the task of helping convert the entire hospital and clinic operation, part of the University of Texas health system, to a team concept. She began in the outpatient operation and more recently, has moved in to work with Marilyn Cage, trainer in the health information department, to complete the transition.
According to Cage, the 10 health information management teams at M.D. Anderson were formed around functional tasks as well as shift requirements to maximize current competencies and balance workloads. Within each team all shifts are covered, and members work overlapping hours. All teams are represented on a team council that meets regularly with management to discuss both the teams’ and customers’ issues.
Team concept flexible
The team concept has given the department greater flexibility to meet the customer needs of both 24-hour inpatient operations and daily outpatient clinics, says O’Shea-Roper.
The department is a year deep into a process that could take two years to finish, judging by the department’s own timeline for the conversion, she says. 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 the staff for the natural ups and downs that come with growth. "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 some unanswered questions and frustration. By the norming stage things are beginning to work out with consistency, and the team is beginning to reach some of its goals. Finally, during performing, they achieve objectives, set their own goals, and constantly work to improve themselves, she says.
"It’s important to note that problems are perfectly normal during the team development process. And 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, O’Shea-Roper asks each team member to sign a contract. It may not carry the force of law, but it does amount to a pledge of that person’s commitment to the team, she says. (For a sample copy of the contract, see p. 77 .)
"During the training, we talk about the new ground rules and new expectations," she adds. "The contract puts in writing what we have talked about during training."
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.
A key element of M.D. Anderson’s hospital-wide change to a team concept is to boost customer service. Although HIM team members have little direct contact with patients, the concept still applies, says O’Shea-Roper. "It is explored during training by understanding that we must see each other as customers as well as the patient.
"In fact, if you, as an employee of M.D. Anderson, can’t define how what you do affects the patient, then something’s missing. The patient is the ultimate focus of all we do, and that is an integral part of working together as a health care team," O’Shea-Roper says.
Lydia Washington, Director of Health Information Management, University of Texas, M.D. Anderson Cancer Center, Houston. Telephone: (713) 792-2121.
Christine O’Shea-Roper, Team Development Manager, University of Texas M.D. Anderson Cancer Center, Houston. Telephone: (713) 794-1026.
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