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Maria Flynn

, and Dave Mercer

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date: 09 May 2021


The importance of teamworking has been long established in healthcare, with nurses working both as part of a nursing team and as members of the wider MDT. Effective organization and delivery of healthcare services depend upon a wide range of health professionals, patients, families, and carers working together to achieve the best health outcomes and quality of life.

Whether healthcare is necessary for an acute illness episode, helping someone with a long-term health condition achieve an acceptable level of function, or supporting a person who is dying, placing people at the centre of care decisions demands effective teamworking.

Understanding the nature and characteristics of teams can help nurses to work effectively and uphold professional caring values when working with people in any healthcare setting. The RCN acknowledges that teamworking is difficult and requires commitment, hard work, and respect. The College also suggests that the essence of good teawork is how individuals communicate and understand their role as part of the team.

Effective teams are innovative and creative, have a focus on quality, and normally have lower levels of stress, all of which impacts on healthcare delivery and outcomes. Effective teamworking is therefore important not only for improving health outcomes, but also for maintaining morale and job satisfaction for nurses and other health professional staff.

Whilst teamworking is accepted as fundamental to care provision, there is an assumption that if individuals work together, they are a team. However, whilst individuals may identify themselves as part of a team, many people work within groups or pseudo-teams. Distinguishing between these concepts is important.

Features of groups and teams


Within the disciplines of psychology, sociology, and organizational studies, a considerable amount of effort has been invested in understanding how collections of people behave together. In terms of working together, a group has been defined as:

  • People who collaborate for mutual benefit and survival.

  • A collection of people, working independently, with a common aim, and who have the ability to act in a unitary manner.


Similar effort has been dedicated to understanding what differentiates a group from a team. It has been suggested that defining features of teams are:

  • Common aims.

  • Shared goals.

  • Complementary skills.

  • Complementary personal abilities.

  • Mutual respect.

  • Interdependence.

  • Collective accountability.

The key differences between groups and teams are summarized in Table 28.1.

Table 28.1 Comparison of group and team characteristics



Workers are independent

Work to a common vision

Ownership and responsibilities are not always clear

Co-ownership of team goals

Lack of trust between members

Open and honest communication

Potential for conflict

Cooperate and aim to understand each other and resolve conflict

Cautious communication

Mutual respect and report

Decisions often made without discussion

Participatory decision-making

Broad range of skills


Pseudo-teams have also been described where there are shared characteristics of both groups and teams. Whilst there may be an apparent commitment to a common goal, individuals effectively remain independent. In pseudo-teams, members do not necessarily share common objectives and have disparate goals and permeable boundaries, and there is uncertainty about who is part of the team.

Characteristics of successful teams

A successful team is characterized as one where members are committed to working well together to a common aim to achieve the best possible results.

  • Recognizing that personal achievement is dependent upon the success of others.

  • Working to a common aim requires all team members to be open and honest and to share the values which underpin their practice.

  • Being aware of personal and professional values and beliefs.

Being confident in the values which underpin nursing practice necessitates an understanding of professional, organizational, and personal values. Professional values are defined within the NMC Code (Teamwork Organizational values are agreed within each healthcare organization and are aligned with the UK NHS Constitution (Teamwork

Personal values are significant in influencing how individual nurses work. Within successful nursing teams, these values are shared and developed to support practice and decision-making.

Team formation

Tuckman’s seminal work on teams suggested that as individuals come together to form a team, they experience four key stages of development and may reach a fifth stage. These are described as:

  • Forming stage—during this phase, individuals come together, behaviour is generally polite, ground rules are established, and team members begin to work to an agreed agenda.

  • Storming stage—this phase is characterized by conflict, with personality differences becoming apparent as members develop a greater understanding of each other. The conflict may not be overtly hostile but will be present within the group.

  • Norming stage—at this phase, the members come together, roles are established and clarified, and there is a sense of a team emerging.

  • Performing stage—this phase is evidenced by effective structures and ways of working together. Mutual trust and respect, effective working, and high levels of morale and job satisfaction are realized.

  • Adjourning stage—this is the phase where the team may become complacent and cease striving to improve. They may become reliant on past performance and begin to focus upon tasks.

This model of team formation assumes that all teams will need to go through the first three stages before they can begin ‘performing’ together. It also implies that every time there is a change in team membership, the team needs to be re-established and the three building phases repeated.

In terms of nursing work, team formation is likely to be something nurses have to deal with on a regular basis. In all areas of practice, there is constant change of team membership, with both student nurses and doctors in training being allocated to clinical areas for clinical placement experience.

Alongside these rotational staff changes, there are also likely to be irregular changes in permanent staff members and organizational and structural changes to contend with, which means many nursing and healthcare teams will be in a state of constant change.

Teamworking in healthcare

It has been established that effective teamworking in healthcare settings requires a culture which values collaborative working. This is enabled through a continual process of engagement, assessment of team effectiveness, team development, and reassessment. Establishing an effective healthcare team requires:

  • Clear team identity.

  • Team objectives—developed by the team in line with organizational objectives.

  • Role clarity.

  • Clear decision-making.

  • Effective communication.

  • Constructive debate.

  • Inter-teamworking—recognizing interdependence between other healthcare teams and professional groups.

Building and maintaining an effective healthcare team is likely to be an ongoing process. The role of the team leader will be fundamental to successful group dynamics.

Functional teams

The functional team is founded on trust and interpersonal respect, which extends to other teams, patients, and the public. The characteristics of functional teams have been described as where all members are able to:

  • Recognize weaknesses.

  • Admit mistakes.

  • Ask for help.

  • Accept questions about their areas of responsibilities.

  • Accept contributions to their areas of responsibilities.

  • Give each other the benefit of the doubt before arriving at negative conclusions.

  • Take risks in offering feedback and assistance.

  • Appreciate each other’s skills and experiences.

  • Focus time and energy on important issues, rather than organizational politics.

  • Offer and accept apologies without hesitation.

  • Be open-minded and responsive.

  • Be prepared to learn.

  • Look forward to meetings and opportunities to work as a group.

A significant number of the characteristics of a functional team are aligned with the behaviours associated with quality-focused care. They also support the establishment of effective nurse/patient relationships and facilitate professional learning and development.

Dysfunctional teams

It is recognized that, for many reasons, some teams do not work effectively. In teams where there is an absence of trust or lack of respect, it is likely that conflict and ineffective working will result.

A pyramid of behaviours in dysfunctional teams have been described by Lencioni (2002) (see Figure 28.1).

Figure 28.1 Characteristics of dysfunctional teams.

Figure 28.1 Characteristics of dysfunctional teams.

Reproduced from The five dysfunctions of a team: a leadership fable, Lencioni P, ISBN 9780787960759, Copyright (2002) with permission from Jossey-Bass and Wiley.

In order to maintain a functional team, it is important that these behaviours are addressed, and once again leadership is crucial in restoring equilibrium and function to the team.

Particularly important for nurses are the team’s characteristics in relation to accountability. Restoration of effective team functioning can be achieved through the rapid identification of problems. Once identified, it is important to address poor performance, ideally as a learning, rather than disciplinary, opportunity and avoid excessive bureaucracy.

Nursing teams

Dynamic and functional nursing teams will be influenced by the quality of leadership and the sharing of values and beliefs. The level of success is indicated by:

  • Lively interesting team meetings.

  • Exploring the ideas of all team members.

  • Solving problems quickly.

  • Expressing conflicting views, without aggression or negativity towards other team members.

  • Creating clarity around priorities and direction.

  • Uniting in the interest of common objectives.

  • Learning from mistakes.

  • Taking advantage of opportunities.

  • Excellent nursing practice and patient care.

Useful sources of further information

NHS England (2014) Working toward an effective multidisciplinary/multiagency teamTeamwork this resource:

Royal College of Nursing. Developing sustainable and effective teams Teamwork

Whelan SA.Creating effective teams. Sage publications: London, 2014.Find this resource:

Aston Organisation Development (team building)Teamwork