It must be understood that not all people who work together are a team. Adair (2009) defined a team as a group of people bound together by a common purpose who perform interdependent tasks, essentially meaning that team members rely on each other to carry out and complete their work, with different tasks allocated to different members (Ruby and DeBowes, 2007; Craig and McKeown, 2015). While veterinary nurses may work within different disciplines, for example as surgical nurses, emergency and critical care nurses and so on, for all veterinary nurses the most likely common goals in practice are the health and welfare of the patients entrusted to their care, and the quality of service they provide to their clients (Dale et al, 2013).
Team dynamics
Tuckman (1965) proposed a model of team development that is still considered influential today. He suggested that teams move through four stages, namely: forming, storming, norming and performing (Box 1). The model was originally interpreted as linear, however it is now recognised as more of a cyclical process as teams are constantly evolving (Craig and McKeown, 2015).
While the performing stage is considered the most productive, it is essential to remember that this is not a place you will reach and stay forever. It takes a significant amount of hard work to reach this stage and a number of challenges within veterinary practice can move a team away from performing. Such challenges include:
Within veterinary practice, teams are constantly evolving as personnel start and leave the role, staff members rotate from different branches and experts visit to host specialist clinics. An effective veterinary practice relies on a stable and functional team to deliver optimal health care; however the challenges mentioned above will mean some reorganisation is inevitable (Dale et al, 2013).
It can be useful for a novice leader to use Tuckman's model to ask themselves two key questions:
Craig and McKeown (2015) suggested that these questions be posed at a team meeting where the leader should effectively listen to the team members' responses. It is likely that differing views will emerge, however Craig and McKeown (2015) suggested this activity is not about achieving consensus; rather it is about understanding these different perspectives and using them to improve overall team performance. Such an activity will permit a novice leader to identify the stage of development their team is in and then explore strategies to help reach the performing ideal.
Teaming strategy
Effective teams have a plan for how people act and work together; this is known as a ‘teaming strategy’. A teaming strategy according to Craig and McKeown (2015) is a plan of how you as leader will hold a diverse group of individuals together. Little (2011) proposed that all team members have two roles to play in a team; their job title and description define their functional role, that is what they do, for example, veterinary nurse or receptionist. In addition, everyone has a team role or roles — strengths they contribute to the team that are less obvious than their functional role, but nevertheless attributes that can boost the effectiveness of the team. The aim of a teaming strategy is to ensure team members communicate effectively and raise issues of concern, bringing together their collective knowledge and experience to bear on issues that arise in clinical practice.
It is beyond the scope of this article to discuss team member roles in detail, however interested parties are advised to look at the work of Belbin (1993) who is a recognised authority on teams and the different role types of team members. Further information can be found at: https://www.belbin.com/about/belbin-team-roles/
Team communication — the dreaded team meeting!
Beyond any doubt, one of the most common elements flagged by teams in conflict includes communication, or lack thereof. Mellor (2014) suggested that no matter in how many different ways and however many times information is relayed, clear and concise communication is key. Team meetings are the obvious place for the exchange of such vital communication; for head nurses however, holidays, absence and shift patterns make it almost impossible to bring large numbers of staff together to discuss issues and share organisational information. The reality of a 24/7 service that may work from different locations is that face-to-face time must be used wisely; Kostner (2001) suggested that such time must be reserved for relationship work, staying connected as professionals and humans and resolving difficult issues and areas of conflict. In a busy veterinary practice, organisational news, key performance indicators and policy updates are often expected to be discussed by teams during their busy working day. When this is not possible, such vital information may be communicated by digital means, however this may mean it is not understood or in some cases even read! Eitel (2014) suggested that key information can be disseminated to team members during a morning ‘huddle’ which involves a 10 to 20 minute meeting held at the start of each day/shift change over. Such meetings allow for the exchange of organisational updates as appropriate and enable the team to discuss key issues and trouble shoot the mechanics of the daily schedule. They also help to ensure effective communication and foster working as a true team.
Regular team meetings often go by the wayside as things get busier; however, Mellor (2014) suggested that this is actually the time when you need them most. A poorly structured team meeting, however, will likely be viewed as a waste of valuable time by a busy and under-staffed team. When executed well team meetings offer the opportunity to build relationships, confirm team direction, re-evaluate immediate team goals, prioritise actions and clarify who is responsible for what (Eitel, 2014). Clarifying roles and responsibilities together with the team's overall priorities facilitates effective management of team workloads. Understanding individual members' priorities and how their progress contributes to the wider team is valuable to understand (Mellor, 2014). In a busy team, it is easy to focus on one's own priorities and deadlines; discussion of individual's priorities and current work load within a meeting can provide an opportunity to identify individual members who may be struggling and allow for appropriate support or performance coaching to be implemented. It is amazing how team members can and do pull together if they are able to see the impact on the team of not reaching their objectives/goal. They will often help each other, which in turn builds good will in the team's ‘bank of support’ (Mellor, 2014).
It is essential that input from the team is sought in these meetings; they should not be viewed simply as an ‘information dump’ from management. Leaders should get into the habit of asking team members big, open questions: ‘What are we doing well?’ and ‘What can we improve even further?’ and ‘What problems are we still tackling?’ As a novice leader it is important not to be disheartened when on first attempt such questions elicit few responses. Mellor (2014) suggested that as a leader evidences his or her commitment to improvement through listening and possibly piloting some of the ideas, team members will become more courageous in engaging in the on-going conversation, and innovative opportunities can follow.
Time is precious in a veterinary practice so a good team leader is one who effectively uses the time to gain the most benefit to both the team and the organisation. It is the author's personal belief that no matter how short on time, success and progress of both the organisation and individuals should always be highlighted within a team meeting to improve morale and provide a boost to an often over-stretched team. Never assume that team members know any of the positives you associate with them or that they ever grow tired of hearing them (Eitel, 2014). Flight (2015) suggested that for many veterinary professionals, the work is a labour of love and a vocation, further suggesting that to be recognised by a leader and thanked for a meaningful contribution means an enormous amount.
Qualities of an effective team leader
To create and build an effective team requires more than an ability to conduct an effective team meeting; it is essential to have an understanding of what people want/expect from their team leader. According to Robinson and Hayday (2009) there are three key qualities that people look for in a team leader:
Supporting a team in difficulty
Craig (2015b) suggested that a team does not fall into difficulty overnight, proposing that it is a pattern that develops over a period of months or years, and the fact that a team is struggling is never a secret. Staff members know and talk about it behind closed doors with their peers. When team dynamics become challenging, this can cause staff members to start behaving badly, cliques may start to form and general feelings of bitterness towards each other, managers and the organisation surface Craig (2015b) suggested that within a healthcare setting, a sense of professionalism means that even when their team is struggling, managers and staff generally work hard to maintain patient safety and quality of care, usually at a cost to themselves. It is therefore essential to pay attention to the ‘stories’ being told in the team, as these can alert leaders to the fact that a team is in difficulty.
As a novice head nurse/team leader, inheriting a difficult team dynamic and changing this is not easy, but it is possible. The reasons that teams fall into difficulty are always complex — there is rarely a single cause, rather a web of causality, including poor behaviour by team members to-wards each other, which cannot be ignored. Where such poor behaviour is identified from an individual, it must be made clear that such behaviour has no place within a veterinary setting. Head nurses/team leaders need to have safe, direct and honest conversations with such individuals about effective team behaviour which highlights why their behaviour towards their colleagues may be inappropriate (Ruby and DeBowes, 2007; Craig, 2015b). It is essential to remember that poor behaviour from a staff member may be due to the challenges they are facing either from their professional or personal life; exploration of such issues is necessary to ensure appropriate support mechanisms, such as coaching, mentoring, supervision or counselling, can be put into place to support change. Depending on the emotional volatility of the issues or the employees, Ruby and Debowes (2007) suggested it may be necessary for a mediator or a facilitator to be present to work through these steps.
It is important to remember that if your team is struggling, you do not have to deal with this alone despite your role as head nurse/team leader; talk to your line manager about it rather than trying to deal with it alone. Talking about it does not mean that you are failing in your role; this is an organisational issue and you may need support/advice from senior colleagues such as your supervisor, manager or human resources team to help you explore the dynamics of the conflict and offer appropriate support, while ensuring that you work in congruence with workplace policy and procedures (Mellor, 2014).
Communication and sharing the vision
You may of course be lucky enough to be promoted to head nurse/team leader within a very cohesive and effective team. It is important to remember, however, that a team can work together for many years without reflecting on the basics of why they are there, together, as a team. Mellor (2014) suggested it can be easy to assume that we all have the same vision and sense of responsibility towards organisational goals. Little (2011) suggested that all leaders have vision; they know where they want to get and what it should look like when they have arrived, further stating that an effective leader will share this vision with the rest of the team.
This is in congruence with Mellor (2014) who suggested that verbalising the vision, at least annually, will help ensure that everyone is moving in the same direction and remind individuals of their overall purpose in the team.
Team resilience
As with all healthcare disciplines, the pace of change is phenomenal in veterinary practice as science and technology progress and the quest to become cost effective becomes a team responsibility. Mellor (2014) used the analogy of a tree that can bend in the wind to describe a team in this ever changing climate, stating that the team that can respond to the changing landscape, indeed, the team that expects a constantly changing landscape, is more likely to deal effectively with the challenges they face.
Taking time out of the workplace to talk and listen to each other beyond the daily work-related exchanges is beneficial to building and maintaining team relationships. Workforce diversity from the mix of cultures and generations can make organising an event that appeals to all team members a challenge. Be sensitive to the fact that not all members may wish to take part — and that is ok! When deciding on a team social event, be mindful of team member personal circumstances such as caring responsibilities or possible financial constraints that may restrict participation. Box 2 details a few examples of ideas to help develop and strengthen teams which need not cost a lot of money or be too onerous to organise.
Knowing where you fit within the team
As a head nurse/team leader, your focus is on delivering or supporting the delivery of gold standard patient care, and your role is to facilitate that through your team. You have a dual role however: to do your own role excellently, ensuring self-leadership and effectiveness, and in addition, you have a key role in empowering each individual in your team to reach their potential in order that they may contribute fully to the team objective (Mellor, 2014). This is a huge responsibility and to a novice leader can at times seem overwhelming — it is however also a great privilege; a leader who is aware of and flexible to the needs of the individual team members will inspire individuals, encouraging them to be the best that they can be.
Conclusion
An effective team is a group of people with specific roles but with complementary talents and skills that are aligned, and committed to a common purpose (Stott, 2017). All teams will move through different stages of development, but are at their most productive when there is a culture of openness and trust, with members working to their own strengths. Head nurses/team leaders should develop a ‘teaming strategy’ to plan how people will act together, and thought must be given to the effective dissemination of key information via appropriate communication channels (Craig and McKeown, 2015).