Team Dynamics.

All of us in healthcare work within teams. But what actually is a team? And what makes it a high performing team?

What is a team?

A team is a group of people with complementary and interdependent skills, working towards a common purpose, and mutually accountable to each other. Most of us can relate to the idea of a common purpose, but to be a team people need to be mutually dependent on each other, and hold each other accountable with regular review meetings.

When I describe teams like that, I realise that much of what gets called a team is actually not a team, but merely a group of people working together.

What is a high performing team?

A high performing team is one that consistently produces better results that other teams. A variety of factors help create a high performing team, including

• clarity of team purpose and goals
• alignment with organisational values and goals
• team psychological safety (see below)
• robust internal decision making processes
• high quality leadership (the most appropriate style of leadership will depend on context; participative leadership often supports high performing teams)
• high quality external relationships and processes
• a culture of learning

Power dynamics

Power is ever present, whether we like it or not, and whether we want to posses it or not. French & Raven note that social power can come from a variety of sources:

• Positional power describes the power that one has due to rank.
• Expert power comes from being recognised as an expert in something.
• Reward power comes from rewarding others.
• Coercive power comes from being able to punish others.
• Informational power comes from having important information.
• Referent power is the power that comes from social norms and modelling behaviours.

Only some of these power sources would be what one might consider to be hard power in organisational settings.

Importantly, power can be good as well as bad. Some circumstances might call for very directing leadership, and the leader can use their power for the benefit of the team and its aims. Some individuals will simply be assigned power by others, whether they want it or not (for example experts, or people whose actions/values are admired), and they can also use the power assigned to them for good.

Hidden agendas

Just like power, hidden agendas exist whether we like it or not. Marshak identifies several types of hidden things.

• Things hidden from others as they are deemed too risky or inappropriate or unsuitable for sharing.
• Things hidden even from ourselves, repressed for being too painful to acknowledge.
• Things hidden from others because they are our secret hopes and wishes.
• Things hidden from ourselves. representing dreams that we dare not dream.
• Things that are out of awareness because they are incompatible with our world view.

So hidden agendas are not just about hiding negatives, positives may be hidden too, and we may be unaware that we are hiding something.

Things that are out of awareness are particularly interesting. Each one of us has a world view, a prism through which we see the world around us. That prism shapes how we see things, and may lead to certain things being invisible to us whilst being obvious to someone else with a different world view. There's none so blind as those who will not see.

Five dysfunctions of a team

In his classic text, Lencioni identified five team dysfunctions. The dysfunctions are hierarchical, in that one leads to the next. Firstly, teams need to start with trust. Without trust, they will be unable to engage in productive conflict. Without productive conflict, there will be no commitment. Without commitment there will be no accountability. And without accountability, there will be no attention to team results.

The model outlines a gradually increasing quality of teamwork, and recognises that without attention to the basics, results will not happen.

Psychological safety

Discussions about psychological safety are common nowadays, but what exactly is it? Clark defines it as conditions where the individual feels included, safe to learn, safe to contribute, and safe to challenge, without fear of embarrassment, marginalisation, or punishment.

Like Lencioni's model, Clark also uses the idea of levels. Without feeling of belonging, one cannot feel safe to learn. Without learning, one cannot contribute. And without feeling safe to contribute, one will not feel safe to challenge.

Conclusion

People often talk about working in teams, but how often are we actually working in groups rather than teams? Team dynamics are complex. Power and hidden agendas are ever present, whether desired or not, and whether seen as positive or negative. Lencioni's five dysfunctions, and Clark's psychological safety levels are useful concepts to examine team dynamics and work on better teamwork to create high performing teams.