Understanding effective teamworking
Given that developing trust and the ability to work collaboratively is at the heart of successful treatment and performance in medical teams, it is crucial we better understand and provide insight into how best to build effective teamwork and collaborative practices between these disparate groups of people.
Task-organisation at such rapid speeds tends to be limited to particular high complex crisis situations, such as the 2011 Tōhoku Tsunami leading to the Fukushima nuclear melt down or certain disaster responses such as the 2014 response to the Ebola pandemic in Sierra Leone or the 2017 response to Hurricane Irma in the Caribbean. In such operations, personnel from different branches of the military may work alongside other government agencies, international partners or even volunteers.
Unfortunately, with the exception of a handful of studies, such as one looking at ad-hoc teams in the Israeli Defence Force, little research thus far has focused on how task-organised teams establish cohesion, collaborative practices and collective goals. And while there has been research on fixed inter-disciplinary teams in high complexity medical situations requiring collaboration between distinct clinical specialties, (such as stroke rehabilitation or mental health primary care) little research to date has addressed such ad-hoc assembled groups in medical settings.
Recent research conducted by the Defence Studies Department, King’s College London, comparing the establishment of cohesion and social identity in distinctive military formations, found that the key to success in task-organised teams made up of different professionals and branches of the military, lay in establishing shared experiences, close proximity and creating team-wide goals.
More specifically, the research showed four key challenges to overcome:
- A lack of concrete knowledge about the trustworthiness and competence of other team members led to categorical assumptions about the occupational value that an individual brings to the team. For example, the initial trustworthiness of a signaller or medic was not based on their personality, but primarily on their particular role in establishing communication lines. However, this also means that inclusion based on the occupational value depends on the particular situation. While an attached medic is highly important during a combat situation, as they keep personnel alive, on a field exercise in the UK they are likely excluded.
- Proximity influences the relationship between trust and cohesion. Giving team-members the time and exposure to get to know each other and develop common communication patterns, in the form of “banter” or opening up about their concerns enables them to judge the character and competency of their new team-mates. Where teams weren’t given this time, due to operational or physical separation, individuals reported feeling isolated and frustrated.
- Establishing superordinate goals is crucial for creating a stronger sense that the team is a cohesive unit, where individuals recognise they are all in the same boat. The best performing teams, consisting of members from very different occupational backgrounds with different procedures, practices and socialisation, were able to transcend their respective rules and practices in favour of creating localised group-specific procedures.
- Recognising the team as a cohesive entity working towards a common goal, relies on the self-categorisation as an ‘ingroup’. Cohesion was therefore enhanced if team members were able to adopt a dominant identity or create a new all-encompassing identity, without which, teams would not see themselves as cohesive, even if they had a high degree of proximity.
Given the importance of cohesion for effective teamwork, stress reduction and resilience, particularly in crisis situations, these outcomes have important consequences for individuals working in task-organised teams assembled to deal with the Covid-19 outbreak. This is especially important as early research at King’s College London suggests that Covid-19 work is impacting key workers’ daily lives and mental health.
The following recommendations for leaders and managers would help improve effective teamwork and collaboration in such teams:
1. Emphasise the value of each individual to the team and enable them to get to know each other. This is especially crucial in the current high stress environment, as ostracisation is likely to increase already elevated stress levels. Given the established relationship between stress and the immune system, which can be detrimental during a viral outbreak, these teams may provide an important source of social support and meaning for key workers.
2. Involve team members in creating goals, processes and communication patterns. As these teams are characterised by a high degree of individual subject-matter expertise, creating successful shared practices, goals and communication patterns depends on the inclusion of all members in a collaborative effort. While this may take some time during the initial stages of team creation, it has been found to accelerate effective collaboration in interorganisational teams.
3. Accentuate the development of a shared identity based on the commonality in the team. Creating common identities depends on the team’s shared objectives. For example, a team of clinical nurses and re-assigned healthcare staff retrained to support an Intensive Care Unit should de-emphasise their individual specialties to develop an identity based on their delivery of immediate critical care. Similarly, logistics personnel responsible for delivering PPE and other critical supplies to hospitals may develop an identity based on their important role in keeping hospitals afloat and people safe. In so doing, both groups transcend previous occupational identities and establish a sense of similarity within the team, which overcomes individual differences.
COVID-19 as an ongoing global health challenge demands collaboration in task-organised teams at hitherto unprecedented levels. Due to the urgency of the situation and the constant recalibration of teams to include new members, personnel often have very limited time to establish cohesion, teamwork and effective processes aimed at the delivery of care.
What was previously a characteristic of extraordinary disasters, such as Fukushima, or complex military operations, is now an important and globally widespread reality of the Coronavirus response. Our research provides insight and best practice for managers and leaders to get the best out of their task-organised teams, thrown together in the fight against COVID-19.
Stefan is a Teaching Fellow at King’s College London's Defence Studies Department, situated at the Joint Services Command and Staff College of the British Defence Academy. His PhD research referred to in this piece has been nominated for the British International Studies Association’s Thesis prize in 2020. Currently, he is pursuing further educational development in Psychology, focusing on social psychology, resilience and decision-making.