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Working With Troubled Teams

Nurse leaders must be up to the challenge to ensure a smoothly running team.

Forming, storming, norming and performing - those are the steps that leadership experts tell us teams go through. Of course, the steps are not necessarily linear and there is no guarantee there won't be setbacks along the way. And, as new members join the team and/or existing members leave, the dynamics of the team change in marked and subtle ways.

For managers, the ability to manage teams effectively is a critical skill. Fortunately, most experienced managers have learned how to do so effectively. But every once in a while something happens to upset things.

Maybe your team is in the "forming" stage. Perhaps a new member has changed the dynamics of the group. Or, maybe the group has been in place for so long that members have become complacent and no longer exhibit energy or enthusiasm related to their jobs.

What can you do to turn around a troubled team?

The first step: gaining clarity and consensus around the team vision.

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A Common Vision

Stuart C. Orr, is the CEO and founder of Vision 2 Execution, a consulting firm based in Los Angeles. Orr has worked with hundreds of CEOs and C-suite executive teams.  Cultures and teams can be turned around, said Orr. While there are numerous components that go into creating a culture that works together to achieve a corporate or departmental vision, Orr noted that having a clearly articulated vision is critical. That vision must also be understood by members of the team.

"While it might seem 'easier' to get a fractured team to work together on a smaller vision - after all, who would suggest a fractured unit take on something 'big' - in fact, it's much harder to get unity and cohesion around a small, incremental vision as opposed to a larger one," said Orr. His recommendation: "Create a large vision for the team to coalesce around and work together on." Make the vision big and bold, he recommends, drawing in the social purpose that is part of the goals - this can be particularly compelling in healthcare environments.

People and teams value the work they do when it contributes to a larger social purpose, said Orr. In addition, he noted, it is helpful to engage the team in creating the vision. "Vision that they contributed to and helped create is one that is more readily embraced," he said. "They are then accountable for the vision they contributed to create.  These are the building blocks to a team working together toward a common vision and becoming a unit that contributes."

When Teams Derail

But despite a common vision that may be well-communicated and achieve buy-in at the outset of a team's formation, over time the team may flounder - and even derail.

Brandon Edwards is the CEO and founder of ReviveHealth in Los Angeles, a strategic communication firm specializing in the healthcare industry. He began his career in operational communications with Tenet Healthcare and has led many hospital and provider team cultural change and change management initiatives.

Edwards tells of a client, a very well-regarded hospital with exceptional customer satisfaction scores, except for a team on a particular unit. What led to that he said, was a variety of issues, which most of the time can be tracked back to a miscommunication, a poor supervisor or a poisonous team worker. In this case, two out of the three existed. To turn the team around, said Edwards, they:

  • Put focused communication and personal attention on that team from the executive level. "We didn't want that team to feel this was acceptable, nor did we want others in the organization to feel it was tolerated."
  • Heightened communication at all levels of the organization from executive management down, focusing on two-way communication.

Those three impacts: miscommunication, leadership and poisonous team members are frequently at the basic of a derailed team, noted Edwards.

Turning Teams Around

Generally, said Edwards, team troubles can be tracked back to "trust and authenticity." Trust means delivering both good and bad news and being transparent. "That trust really comes from relationships," he said. Authenticity also plays a critical role. "When organizations and leaders don't behave in an authentic fashion, teams pick that up pretty fast," he said. That manifests itself in a very poor team dynamic.

Trust is foundational. "In my own experience and I think in the experience of many nursing executives, it is far harder to bring back once it's eroded," said Edwards.

For leaders that means being very cognizant of the critical role you play with your team members, ensuring that you establish an open and honest culture and that you create means of ensuring two-way communication. Listening is key. That doesn't mean that you must "do what your team wants." It does mean that you must be able to convey to them the why behind your decisions and ensure that those decisions are consistent with your shared vision.

Roger Schwarz agrees the leader's role is pivotal. Schwarz is the author of Smart Leaders Smarter Teams (Jossey-Bass, 2013), and an organizational psychologist and consultant to Fortune 500 companies, nonprofits and government agencies. "I propose that creating an effective team starts with making some fundamental choices about how you want to lead," said Schwarz. "These choices reflect your basic values and assumptions about what it means to be a leader and what it means to be a team. I frame them as choices between a traditional self-serving approach to leadership and relatively new, more systemic and sustainable approach to leadership." He points to some specific leadership behaviors that can cause teams to fall short:

  • stating views without asking others for their views;
  • avoiding transparency by withholding relevant information;
  • acting on untested assumptions and inferences as if they were true;
  • focusing on positions, not interests; and
  • controlling conversations in ways that fail to gain commitment from others.

While the leader's role is critical, the leader must also get many moving parts (people) to work together effectively.

Healthcare organizations are service organizations comprised of people. People, obviously, can make or break the team dynamic. Sometimes, said Edwards, bad apples must go. "That's one of the things (leaders) need to do and don't necessarily do," he said. "In a tight labor market where it's hard to find qualified nurses, sometimes people have difficulty recognizing that someone is poisonous and most of the time someone who's poisonous can't be fixed."

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Leaders, he said, need to act much faster to remove poisonous people. That may involve letting them go, or it may mean moving them into another environment. "But, I wouldn't let talent and expertise and skill set and résumé get in the way of removing someone who is poisonous."

Leaders lead and that job is not always easy. But to ensure a smoothly running team, in an increasingly complex and challenging environment, nursing leaders must be up to the challenge.

Lin Grensing-Pophal is a freelance writer.

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