Effective Teams
Making the most of team learning

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Boston University School of Public Health Authors

Contents

Joan Bragar, EdD, Adjunct Clinical Associate Professor
Boston University School of Public Health, Community Health Sciences

What is a Team?

A team is a group of individuals who work together to produce products or deliver services for which they are mutually accountable. Team members share goals and are mutually held accountable for meeting them, they are interdependent in their accomplishment, and they affect the results through their interactions with one another. Because the team is held collectively accountable, the work of integrating with one another is included among the responsibilities of each member.

The purpose of this module is to introduce a culture of shared learning and teamwork. Teamwork is an essential part of any organization where each member in a team with different skill sets work together simultaneously towards the same goal. Oftentimes, teams are randomly assigned. In order for a team to be successful, members in a team must learn to work together. This is a resource to guide you through various components of effective team building skills.

Why Team Learning in Public Health?

In a recent journal article entitled MPH Education for the 21st Century: Motivation, Rationale and Key Principles for the New Columbia Public Health Curriculum, BUSPH Dean Sandro Galea and collaborating authors write:

Module Objectives

After reviewing this module you will be able to effectively launch a team, work in a team to achieve results, and assess the effectiveness of the team and individuals who comprise the team.

The Three Phases of Teamwork

1. Launching a Team

a) Team Contract and Team Agreements

b) Team Site Agreements

c) Ground Rules for Agreements

2. Working in a Team towards Results

a) Critical Roles in Teams

b) Leading through Breakdowns

c) Challenge Model

d) Developing an Action Plan

3. Team Assessment

a) Evaluating Yourself and Team Members

1. Launching a Team

Joan Bragar, EdD, Adjunct Clinical Associate Professor
Boston University School of Public Health, Community Health Sciences

A) Team Contracts and Team Agreements

In order to work effectively in a team, you need to know the strengths and weaknesses for yourself and others. Members of a team will identify their purpose in class and their personal values. This initial meeting will clarify what each team member wants to get out of the project or the course and will work together to build a shared vision for their team's work. Here is the link to an exercise on shared vision that you may chose to work on with your team.

Establishing ground rules is important because they state what people's responsibilities are for approving, implementing, and evaluating activities. By agreeing on these rules via a Team Contract, members of the team will know what they will be held accountable for and what the consequences will be if they do not follow through on their responsibilities.

Link to a PDF file of Team Contract

 
A team contract is an important tool for helping individuals function together as a team. It indicates what is important to the members about how they work together.  

Reflect on the qualities of your team as you consider the following questions.

B) Building shared understanding at the first site visit (This is relevant is your team is working on a site off campus)

Team/Site Agreements

In your first meeting with your client, in addition to getting to know their context and needs, it is important that they understand the scope of the work they will do with your team, and what you will request from them. You will need to have a shared understanding of some of the preliminary expectations you both might have.

C) Setting Team Agreements and Accountabilities

Link to Team Agreement and Discussion Questions (PDF)

Ground rules are an important tool for helping individuals function together as a team. They reflect what is important to the members about how they work together.   Set these at the first meeting. Discussing ground rules after problems arise is much more difficult. Set aside time at your first team meeting to discuss ground rules. All team members should have a chance to provide input.

Ask team members to discuss prior group experiences:

• What worked well?
• What created problems?
• What unique talents/skills/background does each member bring to the team?

Write down the ground rules to which the team has agreed .

(Each member should have a copy of the ground rules. The ground rules should be reviewed periodically).

Questions you can discuss:

• What are the expectations and deliverables for the team?
• What are the standards for meeting attendance, promptness, and participation?
• What roles need to be filled (time keeper, note taker, facilitator) and how will they be assigned?
• How will we make decisions and solve problems?
• How will we handle conflicts?
• How does the team define respectful behavior?
• How will people be held accountable?

For each category, list 1-3 ground rules that your team agrees upon. For each category, please choose one team member who will help keep the group accountable for the established team rules.

2. Working in a Team Towards Results

Joan Bragar, EdD, Adjunct Clinical Associate Professor
Boston University School of Public Health, Community Health Sciences

Use the 4 Player Model to identify team roles and dynamics and use these to improve teamwork.

A) Critical Roles in Teams

Understanding Moves in Teamwork

There are four moves you can make in teamwork. These moves can be played at different times by different people as suggested by the Four Player Model. These are to Initiate: start action, propose new ideas, Follow: accept the idea or proposal for action and support it actively, Oppose: question the direction, and Observe: watch what is going on. In the video below, Joan Bragar explains the model and its usefulness in a BUSPH Community Health Sciences class on leadership. The positive and negative aspects of these moves which we can also consider as roles are summarized in the table below.

. 

Source: David Kantor,  Reading the Room: Group Dynamics for Coaches and Leaders (Jossey-Bass, 2012)

Link to Handout to Help Teams to Have Effective Conversations using the The 4-Player Model.

Link to Explanation of "Moves" in Teamwork and Teamwork Observation Form

Observer Format of Moves in Teamwork

One informative exercise is to observe the interaction of team members in a group. Each time they participate, put an X in the appropriated column depending on what kind of move they are playing: initiate, follow, oppose or observe and make comments about the process.Use the column on the right to make comments on what is the main moves each member played and how they affected the team dynamic.

Source: David Kantor,  Reading the Room: Group Dynamics for Coaches and Leaders (Jossey-Bass, 2012)

Supporting Your Team

To keep the members of your team inspired and motivated, point out and celebrate incremental results, and link those results to specific actions they have taken. Above all, acknowledge and praise both individuals and the team on a regular basis, and be there to support them.

As you team works to face its challenges and implement the action plan, be sure to: 

• show appreciation regularly to individuals and the team for their work;
• acknowledge the challenges they are facing;
• praise them whenever their work is well done, even if it is not at a major milestone;
• thank them for their commitment and their daily efforts;
• recognize them for their accomplishments and show how their work has made a difference

(From Managers Who Lead, by Management Sciences for Health, 2005)

In implementing a new action plan, particularly when it involves changing how things have been done before, you should expect to encounter obstacles. Even though you and your team are fully committed to the plan, you are still learning as you go and finding out what you need to achieve your results. Some times people outside the team (and maybe even some of your team members) may need explanations to understand the reasons for doing things differently and encouragement to try the new way. Other times you may need to work harder on aligning your outside stakeholders around the challenge so you can get their cooperation.

 When you run into a sizable issue, it can lead to a breakdown. How you handle the breakdown is what matters.

B) Leading Your Team Through Breakdowns

To identify signs of a breakdown and diagnose the steps to get the team back on track.

One of the differences between a group of individuals and a high-performing team is that, in a team approach, difficulties and breakdowns are expected and embraced, and the team addresses the breakdowns together. Help your team identify breakdowns and see them as catalysts for understanding what is missing or what stands in the way of achieving the results you desire. 

When they are not handled well, breakdowns lead to minimizing or ignoring problems, blaming each other, or eroding teamwork, trust, and effectiveness. When handled well, breakdowns can be a major source of breakthroughs or finding new ways to approach your work and achieve results. To change how you think about and approach breakdowns, remember that: 

• all large commitments will have breakdowns;
• the greater your commitment, the more and greater the breakdowns will be;
• when there is no commitment, there will be no breakdowns.

It is your job to help your team's members understand how to respond to breakdowns and to work with them to approach problems together and find a way through that will result in new and better ways of doing things.

For ways to lead your team through breakdowns, see the exercise in the handbook toolkit called "Coaching Your Team through Breakdowns." Link to Coaching through Breakdowns

Coaching Your Team through Breakdowns

Objective

This exercise is helpful when a group has experienced a breakdown and needs a process to resolve the issues. Designed for use with a small team that has been working together on an initiative or project, it helps make the process of addressing and resolving breakdowns a non-threatening learning experience.

Process

Step 1. Discuss what a breakdown is...has progress been stopped by uncertainty or lack of clarity? Are there details that seem to be ignored?

Step 2. Discuss new ways to approach breakdowns...remember breakdowns can often be opportunities of "finding a new way" to meet your commitments together.

Step 3. DO NOT AVOID a conversation about a breakdown... distribute the Breakdown Conversation Worksheet (Handout)

Breakdown Conversation Worksheet

Link to a PDF of the Breakdown Conversation Sheet

Think of the breakdown your team has recently experienced, and answer the following questions related to that breakdown.

1. What was the breakdown? Briefly describe what happened.
   __________________________________________________________________________
   __________________________________________________________________________
   
2. What were you committed to? Describe the commitment of you or your team.
   __________________________________________________________________________
   __________________________________________________________________________
   
3. What was missing that caused the breakdown to occur?
   __________________________________________________________________________
   __________________________________________________________________________
   
4. What did you learn?
   __________________________________________________________________________
   __________________________________________________________________________
   
5. What actions could you take now?
   __________________________________________________________________________
   __________________________________________________________________________

C) Using the Challenge Model

Objective

Teams will work together to define current conditions and analyze the obstacles that are in the way of achieving desired results.

 The Challenge Model provides a systematic approach to creating a shared vision of the future and helping teams identify a challenge and a desired, measurable result. The process leads them to assess factors in the external and internal environments related to their desired result, and plan and implement priority actions to address the root causes of their obstacles.

Link to a PDF of the Challenge Model  
                                        

Source: Managers Who Lead, Management Sciences for Health 2005
 

The Steps

1. Review your organizational mission. With your team, agree on a common understanding of your organization's mission
   
2. Create a shared vision. Work with your team to create a shared vision of the future that will help your organization achieve results. What does it look like when you are successful in accomplishing results in this area? This shared vision will inspire the team to face each new challenge.
   
3. Agree on one measurable result. Pick an aspect of your shared vision and identify a measurable result that you all want to achieve and that can be achieved in a short time frame. This measurable result is what will drive your work. Because it is measurable, it allows you to monitor and evaluate your progress toward achieving it. Note that you might decide on a result and then need to change it as you gain more information. As you learn more about the current situation and obstacles you need to overcome, you may need to redefine your stated result until it is appropriate and realistic.
   
4. Assess the current situation. Scan your internal and external environments to form an accurate baseline of the conditions that currently exist related to your selected health area and the chosen health indicators.
    
5. Identify the obstacles and their root causes. Make a list of obstacles that you and your team will have to overcome to reach your stated result. Use root cause analysis tools to analyze the underlying causes of these obstacles to make sure you are addressing the causes and not just the symptoms.
   
6. Define your key challenge and select priority actions. You write your challenge statement as a question: "How will we achieve this result in the face of these obstacles?"   Then select priority actions that you will implement to address the root cause obstacles.
   
7. Develop an Action Plan. Develop an Action Plan that estimates the human, material, and financial resources and the timeline needed for implementing your actions.
   
8. Implement your plan and monitor and evaluate your progress. Support your team in implementing the plan, and monitor and evaluate your progress toward achieving your result.

Source: Managers Who Lead, Management Sciences for Health 2005

Developing an Action Plan

Before you can begin to implement your priority actions, you need to develop an action plan. Developing an action plan is one of the managing practices. The action plan provides you and your team with a clear path for taking action, monitoring progress, and measuring results. At a minimum, an action plan should identify:

• the actions or activities that will be implemented;
• who will be responsible for carrying out each action;
• the human, financial, and material resources needed to implement the actions;
• a timeline showing when the actions will be carried out.

 Plans are much more likely to be implemented and bring results when they:

• are created and owned by the team and reflect the shared vision of the team;
• address a well-defined challenge that is based on an observable gap between desired and actual performance;
• contain measurable indicators that allow you to see that the performance gap is closing;
• Focus on specific challenges and set new priorities as needed;

Align your team members to work together to deal with problems as they arise, mobilize new resources, and align new stakeholders as needed;

• Organize people to do the work in the most efficient and effective way, and re-assign duties or redistribute work or resources as needed;
• Monitor progress along the way and make sure you have a feasible evaluation plan;
• Inspire and motivate people to stay engaged.

Often during implementation, the priorities you have set compete with other urgent work that arises. These competing priorities can divert you and your team from what is most important.

Link to a PDF of the Action Plan Worksheet

Quick Check on the Quality of an Action Plan

To check the quality and logic of your action plan, answer the following questions:

• Are there activities for each of the priority actions?
• Have you included activities for all of the leading and managing practices?
• Is the desired result SMART?
• Have measurable indicators been defined that will tell you whether or not your team has achieved the desired result?
• Do the activities listed in the plan contribute to the achievement of your desired result?
• Are specific people identified to be responsible for the completion of each activity?
• Have all the resources been identified?
• Does each activity have a time frame?
• Is there anything else that you should add to your action plan?

3. Team Assessment - Evaluating Yourself and Team Members

Joan Bragar, EdD, Adjunct Clinical Associate Professor
Boston University School of Public Health, Community Health Sciences

Objective

To identify what worked and didn't work in the team. Each member will be evaluated based on their performance and their initial team contract. 

After Action Review

One way to evaluate the progress and shared lessons learned is through an after action review meeting. Members on a team should discuss what worked well, did not work well and how things should be done differently. Here is the link to an exercise on an After Action Review that you may chose to work on with your team.

Self and Peer Assessment Form

Link to a PDF of the Self and Peer Assessment Form

Below are eight categories that you can use to assess your peers and yourself. For each item, rate each person and yourself using the 4-point scale given. Think hard and honestly about each of the categories and how you and each group member performed. Beside each rating item is a space for comments. Include examples or explanations that will explain your ratings, and your individual or peers strengths and contributions. Do your assessments independently - do not share or discuss your scoring or come to a decision based on a group opinion. A rating should be provided from each team member, based on your perceptions and experiences. Sub mit one form for each person, including yourself, with your name and the assessed person's name on each form.

 Rater's Name:

 Assessment of:

(Adapted from Goldfinch, 1994; Lejk & Wyvill, 2001)

Virtual Leadership Development Program (VLDP)
Family Planning Case Study

From Vision to Action - Putting it all together

The following case study and related documents originated from the Management Sciences for Health's Virtual Leadership Development Program (VLDP). The case demonstrates how to go from vision to action using the challenge model and an action plan. Follow the example to understand the process for addressing the challenge identified by your team and moving from a vision to a clear action plan with specific activities, dates and accountabilities to move your team towards the vision.

Case Study: Gabra Family Planning Association (GFPA)

The Gabra Family Planning Association (GFPA) is an NGO whose mission is to empower women and men from underserved populations with respect to their reproductive health (RH) and family planning (FP). The staff from GFPA is committed to supporting both men and women in their family planning choices and to promoting effective measures to prevent sexually transmitted infections (STIs) and HIV/AIDS. The GFPA senior management team enrolled in the VLDP because they had heard that it would help them to improve their performance as an organization. In scanning their environment as part of the VLDP, they saw that HIV infection rates among women attending their network of clinics were rapidly escalating. GFPA had heard about pilot projects that successfully integrated family planning and HIV/AIDS services in other countries and they decided that this was worth trying.

During the VLDP the GFPA team developed a vision statement for the first time. They focused their vision not on the entire organization but on what they as a team hoped to see as a positive outcome of their work in the VLDP. Their vision was: All women of reproductive age from the communities surrounding their clinics will receive convenient and accessible integrated family planning services including testing for HIV in order to prevent unwanted pregnancies and safeguard the health of their families.  

 The first time they wrote down their challenge they articulated it as follows: How can we successfully integrate Family Planning and HIV/AIDS services so that services for both FP/RH and HIV/AIDS continue to expand and support each other despite our having limited experience with providing integrated services? This challenge was subsequently refined (see completed Challenge Model)

Developing a Measurable Result

Now the time had come for the team to select one measurable result that would move them closer to achieving their vision and address their challenge. They had to set some priorities, and so they chose to focus on a result that would be achievable in the 6 months following the VLDP.

 In order to be as clear as possible about their desired result, they used the SMART approach. SMART is an acronym often used to help teams develop good objectives but it can also be applied to developing a good desired measurable result. There are several definitions of SMART that you will read in the literature, but we prefer the following:

 Specific (S): Is the desired measurable result, as stated, specific enough so that it can be measured by a frequency, a percent or a number?

 Measurable (M): Is the desired result framed in terms that are measurable?

 Appropriate (A): Is the desired measurable result appropriate to the goals and level of the team and to the mission of the organization?

 Realistic (R): Can the desired measurable result be realistically achieved in a short time frame?

 Time-Bound (T):   Is there a specific time period for achieving the desired performance? Can the action plan be carried out with the resources available in the time specified?

Their final measurable result read: By December of this year, four Voluntary Counseling and Treatment (VCT) centers will have 2 providers each who are trained in integrated family planning and VCT, leading to a 20% increase in the number of visits for HIV counseling and testing in which clients are asked about reproductive intentions and are counseled about family planning options. 

Describing the current situation

The next step for the team was to describe the current situation in relation to their desired measurable result and put it at the head of the fishbone diagram. They put down that 40% of visits to the VCT centers currently included counseling about condoms, and they had been told by the VCT providers informally that providers never asked about current family planning methods or about whether clients wanted to delay or prevent pregnancy. Providers at the VCT centers referred clients who were HIV positive to the GFPA clinics for counseling about family planning. The team wrote down this information at the head of the fishbone diagram. They made a note that they would have to include the collection of data in their action plan in order to establish their baseline and be clear on the current situation. 

Analyzing Root Causes

As a first step in analyzing root causes the team members asked themselves why they hadn't already achieved their desired result if it was so important. They looked at the blank fishbone diagram and brainstormed, under each of the categories, the obstacles that they saw.

 Look at the results of this brainstorm from GFPA in the completed fishbone diagram below. Text description of the figure.

Let's continue with the case to see how GFPA framed the challenge and how they used the Fishbone diagram and the "Five Whys" to analyze root causes.

When the GFPA team filled out their fishbone diagram they saw that there were a number of causes of the current situation that had to do with processes and procedures, policy, people, and the environment. Not all of these were appropriate for them to address.

Then the team used the Five Whys method to get at the root causes of the most important of these primary causes. The "Five Whys" method can be used on its own or it can be used, as the GFPA team did, together with the Fishbone diagram analysis to deepen understanding of the various root causes. Let's look at the results of their analysis below for four of the root causes they identified.

Completing the Challenge Model and the Action Plan

The next step for the team was filling out the Challenge Model. They placed the team's vision at the top, followed by the desired measurable result they were seeking. Then they filled in the root causes on the left and the priority actions on the right that would specifically address each of those causes. At the very bottom they put their challenge statement which was richer due to what the team had discovered during the root cause analysis. Below is the team's completed Challenge Model:

Link to text description of the completed Challenge Model

Developing the Action Plan

Now the GFPA team was ready to develop their action plan that contained the specific activities to achieve their priority actions to address the challenge. Based on their root cause analysis they decided their four priority actions would focus on:

1. Working with the MOH to develop draft guidelines to integrate family planning and VCT that can be tested in the pilot project
2. Educating donor and senior MOH officials about FP as a critical intervention to reduce the spread of HIV/AIDS, using compelling evidence
3. Integrating practical experience in integrated counseling into provider training
4. Hiring more women counselors for VCT centers and providing female clients with an escort home after hours

You can think of this action plan as a map that will start from the first step you have to take to reach your desired measurable result at the end of the journey.

Developing an action plan is not as easy as you might think. Your team has probably done countless action plans in the past, but you have probably not found them very useful as a management tool. We are so used to doing what we have always done, whether it be carrying out trainings or holding meetings that we forget that these activities may not be enough to affect the root causes that we identified in "Five Whys" and the "Fishbone Diagram."

Below you will see the GFPA team's action plan. They wrote down their challenge and their desired measurable result at the top left of the action plan sheet. Then they wrote down the indicators on the top right. Then they put all of the activities that they would implement to conduct the priority actions they selected.

Action Plan of Team: GFPA, Integrating Family Planning into VCT services

Date: May 9, 2008

Checking the Quality of the Action Plan

Link to a PDF of the Action Plan Checklist

For a final check, look back over the action plan for GFPA and answer the following questions:

Do you think the activities in the plan address some of the important root causes?

________________________________________________________________________________________________________
________________________________________________________________________________________________________

Is the desired result SMART?

________________________________________________________________________________________________________
________________________________________________________________________________________________________

Have measurable indicators been defined that will tell GFPA whether or not they have achieved their desired result?

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

Do the activities listed contribute individually and as a whole to the achievement of their desired result?

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Are specific people identified to be responsible for the completion of each activity?

___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

Have all the resources been identified?

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Is there anything else that they should add to their action plan?

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Source: Managers Who Lead, Management Sciences for Health 2005

Faculty Resources for Team-Based Learning  

Managers Who Lead (most of the tools come from this toolkit)

http://www.msh.org/resources/managers-who-lead-a-handbook-for-improving-health-services

D.Kantor. (2012)  Reading the Room: Group Dynamics for Coaches and Leaders. Jossey-Bass

Represented here as best practices for designing group projects, this site from the Eberly Center for Teaching Excellence and Educational Innovation at Carnegie Mellon University suggests ways to create interdependence, promote teamwork skills and build in individual accountability.

(http://www.cmu.edu/teaching/designteach/design/instructionalstrategies/groupprojects/design.html)

The centerpiece for this site is the book, Getting Started with Team-Based Learning by Jim Sibley.He is the Director of the Centre for Instructional Support at the Faculty of Applied Science at University of British Columbia (UBC) in Vancouver, Canada. This extensive resource discusses how to use teams properly, ensure student readiness, promote problem solving, and make student accountable. It includes a variety of resources including videos.

http://learntbl.ca/

This site from the Team-Based Learning Collaborative suggests ways to get started with teams, form teams and orient students and do peer evaluation among other things. A very extensive resource...

http://www.teambasedlearning.org/

From the site described above this 4 page 11"x17" handout provides a good overview of the rationale for team-based learning and many of its guiding principles.

http://www.teambasedlearning.org/Resources/Documents/TBL+Handout+Aug+16-print+ready+no+branding.pdf

This site from Iowa State University's Center for Excellence in Learning and Teaching provides videos and examples on how to effectively employ team-based learning.

http://www.celt.iastate.edu/teaching-resources/course-planning/specific-approaches/tbl/

This page from the Team-Based Learning Collaborative web site provides an exhaustive list of online resources related to Team-Based Learning.

http://www.teambasedlearning.org/refs/

R. Stein and S. Hurd (2000) Using Student Teams in the Classroom, Anker Publishing, Bolton, MA

The web site, FreePD, provides resources that can be useful to professors or instructors teaching in the post-secondary sector. This posting provides a link

to an 11-minute video on teaching groups to work effectively:   http://rodcorbett.com/freepd/teach/video-teaching-group-effectiveness/

Sample rubrics and related documents for individual and team evaluation (SPH faculty)

Improved group work by applying "team-building" tools and approaches ( Taryn Vian, Department of Global health)

Assessment Tool Examples (Taryn Vian, Department of Global Health)

Rubric for Assessment of Team Effectiveness (Kathleen Macvarish and Harold Cox, Office of Public Health Practice)

Rubric for Assessment of Individual Team Members (Kathleen Macvarish and Harold Cox, Office of Public Health Practice)

Scoring Rubric for Final Group Presentations (Richard Laing, Department of Global Health)

Group Project Evaluation Form (Wayne LaMorte, Department of Epidemiology)

Post-Module Feedback

Link to Post-Module Feedback Survey