1. Cox, Sharon RN, MSN, CNAA

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Real teamwork helps teams really work.


Although nurse managers place "promoting teamwork" high on their list, most spend more time talking about it as a concept than making it a day-to-day reality. When trying to promote real teamwork on your unit, consider Patrick Lencioni's teamwork essentials. 1


1. Trust level. It's essential to build teamwork on trust. You reflect your trust level in your ability to be genuine and honest with coworkers about needs or frustrations and lessons learned from mistakes. When staff members trust each other, they can offer and accept apologies, take risks in giving or receiving feedback, and admit areas of weakness. Learn to reveal vulnerability as a prerequisite for building trust levels in a team.


2. Healthy conflict. Effective teams talk through their differences rather than act them out. These teams discuss issues without personalizing them or holding grudges. Acknowledge conflict as a natural and productive part of the problem-solving process. Model this concept by bringing conflicts into the open without overly protecting staff on sensitive issues. Skill set training in ways to respond to difficult behaviors or assertiveness can also assist in dealing with conflict. Show your staff members that they can have a different view and still be seen as team players by saying things like, "That's a good point. Is there a counter point to that idea?"


3. Commitment. The presence of trust and the ability to work through conflict provide the basis for commitment or "buy-in" on group decisions. Knowing that it heard all ideas in unfiltered debate, the team can make a decision based on its collective wisdom and speak with one voice as it moves forward. Stress the value of learning from mistakes as a means of building team commitment. You can promote this commitment by taking time at the end of staff meetings to review decisions and get everyone on the same page.


4. Accountability. Effective teams recognize that they actually improve their overall functioning if members exert the effort to "hold each other's feet to the fire." For example, the evening staff on a postpartum unit confronted one of its colleagues who had an attitude problem by saying to her: "We're each going to take one of your patients tonight, and you need to go home and do something about your attitude before you come back to work. We don't need the chronic negativity, and the patients don't need it either." Having a team develop behavior standards, ground rules, or group agreements encourages staff accountability for creating a healthy work environment.


5. Attention to results. Leaders reinforce effective teamwork when they emphasize results. For example, you set the tone for a focus on outcomes when you work with staff to establish group goals to reduce patient falls and infection rates, or to improve retention and patient satisfaction scores. Visually tracking results and recognizing those who make significant improvements provide ways to foster a results-oriented team. Benchmarking with similar units or routinely sharing best practices from other facilities provides additional mechanisms to move from a culture of "good enough" to one that really achieves.





1. Lencioni, P.:The Five Dysfunctions of a Team. San Francisco: Jossey Bass, 2002. [Context Link]