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Authors: Kristin Watson, PharmD, BCCP; Brent N. Reed, PharmD, MS, BCCP; Zachary R. Noel, PharmD, BCCP; Stormi E. Gale, PharmD, BCCP; Sandeep Devabhakthuni, PharmD, BCCP

It the first part of this two-part blog series, the fundamentals for a high-performing team were discussed (Figure). In the second part of this two-part blog, we discuss challenges that can arise within a team and how to overcome these. We also detail the benefits of teamwork and provide suggestions for creating a team.

Obstacles are unavoidable for any team. It is necessary to develop strategies to minimize the effect challenges have on forward progress. Problems should be identified and corrected in a timely manner, and steps to prevent something similar from happening again should also be developed. Taking shared responsibility is essential for success and addressing challenges. This creates an environment where individuals are comfortable speaking up when challenges arise.1

It is also important to identify a coach, outside of the team, as input from higher ranking individuals has been shown to be beneficial. The person(s) selected to help a team navigate these challenges should be someone that is accessible and trustworthy.2 Seeking input can enable a team to collect unknown information, seek alternative approaches, reassess their strategy and/or improve confidence with decision making.3,4 For ATRIUM, the department chair has provided invaluable input, wisdom, and experience on navigating unforeseen obstacles. Additionally, the department chair has been fundamental in establishing connections.

There are several types of challenges described in the literature that can plague teams:

Diffusion of responsibility is when an individual feels less accountable for a team’s output and goal attainment than he/she would if working alone. 5,6 This term was first used to describe the “bystander effect” – people are unlikely to help someone in dire need when others are present.39 Diffusion of responsibility can decrease motivation and productivity, and appears to be more pronounced as team size grows.6,7 Furthermore, it can lead to competition, moral disengagement, and poor decision making.6,8 ATRIUM has worked to ensure that the roles and responsibilities of each team member are clear. Equal distribution of work has been improved by establishing team leads and accountability is maintained through our reporting structure.

Sunk cost fallacy can also be detrimental to teams, particularly if it coexists with diffusion of responsibility. This type of biased thinking occurs when commitment to a project continues solely based on the time and resources that have already been invested, and often makes teams unwilling to discontinue a project out of concern that prior efforts cannot be recouped.9 However, terminating such a project may empower the team to supplant this with a new goal. Replacing a goal for which motivation is lost may permit for reallocation of efforts toward an endeavor determined to be more worthwhile.10,11 ATRIUM combats this by regular, thoughtful re-evaluation of projects and goals. The workload, return on investment, and individual member satisfaction for each activity is assessed. For example, ATRIUM suspended select projects, such as hosting continuing education programs, to focus on activities that create more traction. This also allowed members to focus on efforts that were more rewarding and/or had a greater perceived return on investment.

Groupthink, also known as a fear of conflict, arises when harmony between group members is prioritized. This phenomenon can lead to dysfunctional and poor decision making.12-14 Forming strong relationships and trust is paramount to avoiding this type of problem. The relationship between collaborative members allows them to speak freely and voice their opinions as well as being receptive to criticism.15 Teams should set the expectation upfront that a consensus is not required in order to make decisions. Additionally, the risk of groupthink can be minimized if members do not self-censor their input on a topic.13,16 ATRIUM has tried to reduce the risk of groupthink by working to create an environment where each member is encouraged to bring ideas forth to the team for discussion. Members also recognize that criticism of such ideas is not personal.

Shared information bias, in which team members spend the majority of meetings discussing material that each person already knows instead of new information, is another common challenge. Strategies to mitigate this type of bias include allowing individuals to share their areas of expertise and providing sufficient time during a meeting for discussion.17,18 It is important that other members of the group do not take the expert’s input as the only suitable approach; team members should be encouraged to provide input to ensure that the best decision is made. The team leader should facilitate input from all team members and ensure that each person’s perspective contributes to the final decision.17,19 The majority of time spent in ATRIUM team meetings is dedicated to problem-solving and positive conflict. This is possible as items that do not require discussion and are easily communicated via email (e.g., progress updates) are shared in advance of the meeting.

One of the reasons that the ATRIUM Cardiology Collaborative is productive is because each member is invested. Rotating roles every few years has provided opportunities for innovation while preventing monotony for team members. A permanent team allows for short-term and long-term goals (e.g., over 2 years or more). Recognizing and utilizing individual’s strengths have been equally instrumental for innovation and progress. This can be accomplished through sharing and reviewing other’s talents as determined by the ClintonStrengths® (formerly known as StrengthsFinder).

ATRIUM Cardiology Collaborative members recognize each other’s interests through working together on a number of projects over the years. Responsibilities are assigned to members and care is taken to ensure a balanced workload. This structure has enabled all members to find joy in their work. Additionally, the supportive nature of the group allows team members to explore innovatively.

Members of the Collaborative attribute many of their accomplishments to the evidence-based principles outlined in this paper. The team, as well as each individual, has increased their recognition on the local and national level as a result. Several projects may not have been achieved without a formalized group (e.g., app development, regular blog posting). Most importantly, each member is highly engaged and fulfilled with the opportunities afforded through this team. There is no doubt that individual and group successes stem from this formalized team and the perpetual support of others.

Forging strong relationships can carry over to different aspects of one’s life or career. ATRIUM Cardiology Collaborative members share personal and professional accomplishments and challenges. The group provides a safe and supportive network where individuals can grow and succeed.

Suggestions for Creating A Team
Others may wish to consider a similar program within their institution at a local or national level. The following areas should be considered and can also be applied to committees on which an individual serves.

  1. Assess if team members can dedicate the time to contribute and/or the supervisor(s) will allocate effort for team activities.
  2. Determine each member’s strengths and areas of interest. Interest areas do not have to be the same for each member.
  3. Find a coach who will provide support and believe in the mission, vision, and goals. This person should also be able to help when challenges arise. He/she should encourage innovation.
  4. Identify funding opportunities, including a constant funding source to support innovation and other endeavors.
  5. Follow the five principles for a high-functioning team outlined by the National Academy of Medicine (see Figure).
  6. Schedule routine team meetings and discussions with the coach.
  7. Try something new! Conduct a SWOT (strengths, weaknesses, opportunities and strengths) analysis to find your niche area(s).

The ATRIUM Cardiology Collaborative has been a dream opportunity for each member. The accomplishments are based on equal contributions, selflessness, and constant support from each member. Following the principles for team-based care outlined by the National Academy of Medicine can optimize the team’s effectiveness. These principles lend themselves to the creation and maintenance of other non-patient care teams.

Kristin Watson, PharmD, BCCP

Dr. Watson is an associate professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and practices as a clinical pharmacy specialist in the ambulatory heart failure clinic at the Veterans Affairs Medical Center in Baltimore, MD. Follow her on Twitter @cards_pharm_gal

Brent N. Reed, PharmD, BCCP, FAHA

Dr. Reed is an associate professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and practices as a clinical pharmacy specialist in advanced heart failure at the University of Maryland Medical Center in Baltimore, MD. Follow him on his website or on Twitter @brentnreed.

Zachary R. Noel, PharmD, BCCP

Dr. Noel is an assistant professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and practices as a clinical pharmacy specialist in cardiology at the University of Maryland Medical Center in Baltimore, MD. Follow him on Twitter @ZacNoelCardsRx.

Stormi Gale, PharmD, BCCP

Dr. Gale is an assistant professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and practices as a clinical pharmacy specialist at the University of Maryland Medical Center in Baltimore, MD. Follow her on Twitter @stormigale.

Sandeep Devabhakthuni, PharmD, BCCP

Sandeep Devabhakthuni is an assistant professor in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and practices as a clinical pharmacy specialist in advanced heart failure at the University of Maryland Medical Center in Baltimore, MD. Follow him on Twitter @deepdev511


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Teamwork Makes the Dream Work: Enhancing Employee Productivity, Engagement, and Satisfaction Through a Culture of Collaboration: Part 2 of 2

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