Fostering a Team Culture in a Healthcare Setting: Strategies for Success

The article discusses the importance of teamwork in providing quality patient care, particularly in healthcare settings where collaboration and communication are crucial. The author suggests that teamwork can be enhanced by implementing strategies such as articulating actions, establishing relationships, maintaining friendly ties, and managing conflicts. Additionally, the Salas framework, which includes monitoring performance, adaptation, and integration, can be used to foster a positive team culture. The author emphasizes the importance of communication, building and maintaining relationships, and asking for help when needed in order to achieve quality patient care and safety.

School of Nursing
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Assessment Title: TEAMWORK IN NURSING

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Teamwork in Nursing
Introduction:
Teamwork is an essential part of everyday work life. Even more so in nursing.
Healthcare is an industry that includes doctors, nurses and allied health that all work together
to problem solve, develop strategies and provide and manage patient care. Many factors
affect the professional relationships within the team environment in nursing practice. Factors
that impact on the team’s relationship include inexperienced leadership skills, staff morale,
working conditions and lack of a performance appraisal system (Awases, Bezuidenhout, &
Roos, 2013). Using the Bain model, this essay will explore this model and identify issues, the
significance of teamwork and finally discuss strategies for successful teamwork.
Identifying the issue:
It was on a busy Saturday night in the emergency department, and we were under
staffed. The shift started off as usual until approximately 1 AM when the shift started to fall
apart. Communication amongst the team began to deteriorate. An argument between a
colleague and myself erupted as she had left a patient unattended because she thought I
would deal with the situation since she had an emergency. Needless to say, before the shift
was over no communication existed.
The events of that night left me feeling disappointed and angry with myself. I could
not understand why we could not just work together and provide adequate patient care despite
being overworked. I felt annoyed that the other team members expected me to do their work
for them while still doing my job. To some extent, I blamed myself for the argument since I
had chosen to ignore the patient since it was not my responsibility. I also thought that I
should express my feelings in a way that did not result in conflict. I felt I was to blame for
the lack of communication and coordination among us.

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The theory on teamwork by Tuckman (2013) describes how teams undergo four
stages of development before they can function as a team. The first stage is the finding where
individuals are getting to know each other and learn their roles. The second stage is the
storming where conflicts arise as people start to identify themselves as members of a team.
Conflicts may also arise due to conflicting interests since the members are yet to know each
other. In the third stage, processes and rules are established. Performing is the last stage
where members begin to thrive as a team (Newland, 2015). Based on this theory, our team
was in the second phase where members were arguing and confronting each other. Therefore,
if we overcome the different stages, we can provide patient care as a team.
Teamwork in nursing occurs when nurses work together towards a shared purpose. As
aforementioned, teams undergo different stages of development. One reason why the issue
arose is that our team was undergoing the second phase of development where our team
members had not yet identified their roles. The second reason for the conflict was the lack of
communication among us which may have been due to lack of trust. The third reason is that
we did not have an established strategy to plan or any working processes (Craig & Mckeown,
2015). It was challenging to determine who was supposed to do what task and when. We
were also unable to discuss and identify what our individual strengthens were to maximise
our care plan.
From this experience, I have learned that the lack of teamwork could lead to
inadequate patient care and conflicts with team members. As a graduate registered nurse, I
will be required to collaborate with nurses, and other professionals in the healthcare industry
to problem solve, develop and manage patient care. Therefore, I must develop strategies that
will assist me to work more efficiently in a team whilst understanding the different stages of
development. I should also learn to be adaptable to changes and being aware of how different
each person is (Elrick, 2016).

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The significance of teamwork:
Teamwork in the healthcare industry should lead to quality and efficient patient care,
such as the integration of services among health providers which can ease access to
healthcare for communities in remote areas (Pinto et al., 2012). According to the Canadian
Health Research Foundation, for teams to function correctly there must be a clear purpose
and strategies to implement the processes (Brault, 2014). A successful team in this industry
works towards the comprehension of a patient’s issue and providing recommendations after
having discussions with other professionals (Pinto et al., 2012).
Teamwork reduces the probability of error, which increases the patient’s safety
(Thompson, 2011). Working as part of a team encourages nurse-doctor discussions that lead
to a discussion on different perspectives on patient care, and in turn, provide the best outcome
for the patient. It may also lower the rate of nursing burnout (Gandi, Wai, Karick, & Dagona,
2011). Burnout can occur due to stress related to the workplace environment and home life.
It is often present when nurses are emotionally exhausted and feel they have failed to
accomplish their goals (Gandi et al., 2011). Teamwork assists in redistributing the workload
and helps to ensure no one is overdoing it.
Teamwork can also lead to a higher job satisfaction amongst nurses. It can be
attributed to better patient outcomes and more satisfied patients. ("Factors Related to Job
Satisfaction Among Nurses," 2016). Patient’s families are also satisfied with the quality of
patient care provided by specialists when the treatment is based on collaboration (Sharma, &
Chowhan, 2012). Lastly, the medical industry nowadays offers specialized treatments
making patient care more complex (Flieger, 2017). The complexity of patients today
highlights the need to work collaboratively.

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Professional strategies:
Two types of teams consist. The first is the group team where actions overlap and
members are grouped depending on the actions (Mazzocato, Forsberg, & Schwarz, 2011).
The second group is the integration where members can articulate themselves and interact
with each other (Mazzocato et al., 2011). Teamwork that is aimed at providing better health
practices should integrate the members in all stages of development. However, teamwork is
challenging to achieve in the emergency room due to the massive amount of work demanded
from health professionals and the overcrowding of patients (Mazzocato et al., 2011). In my
experience, the critical aspects of teamwork are communication, conflict resolution, task
assignment, and planning (Mazzocato et al., 2011).
The theoretical framework developed by Salas is used to define aspects that lead to
effective teamwork (Salas, 2015). According to the Salas framework, five factors contribute
to teamwork (Salas, 2015). The first element is team leadership, which states that leaders are
supposed to organize and manage the activities of the entire team. The second element is
collective orientation where everyone is involved in the decision-making. The third element
is mutual performance monitoring where members are supposed to monitor the performance
of each other. The fourth factor is backup behavior and being able to adapt is the last one
(Marques, Ramos, Passos, & Curral, 2015). The Salas framework also has three concepts that
result from teamwork namely communication, trust, and similar mental models (Marques et
al., 2015).
This framework can be used to create a strategy to implement teamwork in nursing.
To demonstrate this, a project on how a process improvement program would affect
teamwork of nurses in a hospital was carried out ("When Nursing Teamwork Suffers," 2017).
The research was a new program that was introduced and implemented by the management to

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improve teamwork. Data was collected using focus groups and surveys. The analysis of
repetitive patterns was done using Salas framework (Salas, 2015). The survey used to collect
data from the nurses was also derived from the framework. The findings revealed that a lack
of leadership led to the low job satisfaction among the staff. This evidence proved Salas
theory that states that leadership affects the morale of the members.
Therefore, my strategy to boost teamwork would be to select a leadership team that
understands the needs of the team members in the nursing profession. The leaders would
develop policies that foster teamwork amongst the health professionals. The next step would
be to encourage feedback from the members to improve teamwork. Performance monitoring
is also a collective responsibility (Salas, 2015). This would hopefully ensure that nurses
would support each other and demonstrate being highly adaptable to change within the team.
Finally, the plan would include the evaluation of factors that lead to team failure and
eliminating this. Lencioni (2013) stated that the five components that may lead to the failure
of a team. This includes lack of trust, being afraid of conflict, failure to commit, lack of
accountability, and failing to pay attention to results.
Another research study on strategies was carried out that identified how to boost
teamwork in a hospital in Southern Brazil (Santos, Lima, Pestana, Colomé, & Erdmann,
2016). The methods used to collect data were participant observation and semi-structured
interviews. Based on the findings, the strategy was divided into four principal factors namely:
the articulation of actions, the establishment of relationships, maintenance of friendly ties and
conflict management. This strategy can also be applied to my situation (Santos et al., 2016).
In my case, using the Salas framework, I could ask for the collective contribution of
everyone in this phase. For example, in the articulation of actions, nurses need to use
managerial skills and organize the department. Providing patient care above and beyond what
is expected would be advantageous (Santos et al., 2016). Collaboration amongst the

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healthcare team will progress the processes. Building effective rapport and relationships are
often a result of excellent communication skills. Working as a team within the emergency
department would provide best patient care especially when there is overcrowding. Skill mix,
time management skills and asking for help when you need it are all part of teamwork.
The Salas framework on monitoring performance can be used in collaboration with
the maintenance of friendly ties. It is important because people tend to dislike certain traits
about each other. According to that study, arguing and fighting does not build friendships
(Santos et al., 2016). One way of fostering a bond is to do activities that are outside of the
workplace. For example, nurses can plan fun activities on holidays and support each other in
case of death or burial ceremonies. Managing conflict in a friendly manner provides a safe
workspace. Additionally, the leaders should monitor conflict resolution.
The Salas framework also includes adaptation. The strategy must incorporate the
well-being of health professionals and the safety of patients, which will assist in adaptation. It
is based on research, which was carried out to determine the relationship between teamwork
and the wellbeing of professionals and the safety of patients. The study involved the
collection of ninety-eight studies to provide evidence of the causal relationship (Welp, &
Manser, 2016). The outcome of the research was that the three concepts should be adapted
using integration. It means that teamwork can be seen as a means to improve the other two
concepts. The teamwork should also include other professionals in healthcare. Similarly, in
this case, the strategy to develop teamwork must depend on the safety of the patient and the
wellbeing of the staff members. It can be achieved through communication among all the
people involved.
Conclusion:
Teamwork plays an essential role in the provision of patient care, such as reducing
medical errors, lowering burnout, and increasing job satisfaction. The professional strategy

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that can be used to enhance teamwork should include a leadership team, feedback,
performance monitoring, and the elimination of factors that strain collaborative practices.
The strategy should be implemented based on Salas framework, which can be integrated with
the four elements (the articulation of actions, the establishment of relationships, maintenance
of friendly ties and conflict management) that enhance relationships as mentioned earlier.
Additionally, the inclusion of the whole team in the decision-making process will benefit the
patient and team in achieving quality patient care and safety. Lastly, communication, building
and maintaining relationships will continue to play a vital role in improving teamwork as it
has been proven to decrease conflict and maintain professional relationships.

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References
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